Mercy Seat Mental Health Treatment Center LLC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

Legal business name

MERCY SEAT MENTAL HEALTH TREATMENT CENTER LLC

Practice address

1640 2ND St Ste 105
Norco, CA 92860-2983

Phone

(424) 221-0834

Fax

(951) 407-1042

NPI assigned

Nov 30, 2022

Organization subpart

No

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

Authorized official

Name

Stella Alah-Tih Fongod

Title

Owner of the Entity

Phone

(424) 221-0834

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Stella Alah Tih, NP

  • Psychiatric/Mental Health Nurse Practitioner
  • Carlsbad, CA
  • NPI 1992347629
  Medicare reassignment NPD

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

{
    "created_epoch": "1669766400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1714435200000",
    "number": "1043920119",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1640 2ND ST",
            "city": "NORCO",
            "state": "CA",
            "postal_code": "928602969",
            "telephone_number": "424-221-0834"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1640 2ND ST STE 105",
            "city": "NORCO",
            "state": "CA",
            "postal_code": "928602983",
            "telephone_number": "424-221-0834",
            "fax_number": "951-407-1042"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MERCY SEAT MENTAL HEALTH TREATMENT CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-11-30",
        "last_updated": "2024-04-30",
        "certification_date": "2024-04-30",
        "status": "A",
        "authorized_official_last_name": "FONGOD",
        "authorized_official_first_name": "STELLA",
        "authorized_official_middle_name": "ALAH-TIH",
        "authorized_official_title_or_position": "OWNER OF THE ENTITY",
        "authorized_official_telephone_number": "424-221-0834"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Psychiatric/Mental Health Nurse Practitioner in Norco, CA
• Providers in Norco, CA by specialty
• Psychiatric/Mental Health Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2024; 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.