NPIMap

Organization Active NPI

Adom Telepsychiatry and Mental Health Services a Professional Nur

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Riverside, CA
National Provider Identifier
1003407388
Registry record updated Jan 10, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
ADOM TELEPSYCHIATRY AND MENTAL HEALTH SERVICES A PROFESSIONAL NUR
Practice address
4199 Flat Rock Dr Ste 148
Riverside, CA 92505-7115
Phone
(951) 707-7471
NPI assigned
Jan 29, 2021
Last updated
Jan 10, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 10, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Gladys Obeng, DNP,BSN, RN, PMHNP-BNPI 1356559553
Title
DNP
Phone
(951) 707-7471

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X Primary

Addresses

Primary practice location

4199 Flat Rock Dr Ste 148
Riverside, CA 92505-7115

Mailing address

PO Box 77331
Corona, CA 92877-0111
Phone (951) 254-3558

Other practice location 1

8350 Archibald Ave Ste 110
Rancho Cucamonga, CA 91730-3670
Phone (951) 254-3558

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220729001082 CA Part B Supplier - Clinic/Group Practice 9234511882 Practice locations: Rancho Cucamonga, CA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1611878400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1673308800000",
    "number": "1003407388",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 77331",
            "city": "CORONA",
            "state": "CA",
            "postal_code": "928770111",
            "telephone_number": "951-254-3558"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4199 FLAT ROCK DR STE 148",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925057115",
            "telephone_number": "951-707-7471"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8350 Archibald Ave Ste 110",
            "address_purpose": "LOCATION",
            "city": "Rancho Cucamonga",
            "state": "CA",
            "postal_code": "917303670",
            "country_code": "US",
            "telephone_number": "951-254-3558",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ADOM TELEPSYCHIATRY AND MENTAL HEALTH SERVICES A PROFESSIONAL NUR",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-01-29",
        "last_updated": "2023-01-10",
        "certification_date": "2023-01-10",
        "status": "A",
        "authorized_official_last_name": "OBENG",
        "authorized_official_first_name": "GLADYS",
        "authorized_official_title_or_position": "DNP",
        "authorized_official_telephone_number": "951-707-7471",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DNP,BSN, RN, PMHNP-B"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Riverside, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.