Samuel Campbell Jr.

Primary specialty

Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X

License

157806092 Issued in CA

Practice address

4200 Crescent Rock LN
Bakersfield, CA 93311-2860

Phone

(310) 930-0199

Fax

(818) 475-1914

NPI assigned

Sep 11, 2020

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Willie Young's Home for Young Men

  dba Walt's Home for Young Men

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Bakersfield, CA
  • NPI 1548859556

  Residential Treatment Facility, Emotionally Disturbed Children

  NPD Authorized official
• Willie Young's Home for Young Men

  dba Walt's Home for Young Men 2

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Bakersfield, CA
  • NPI 1720757891

  Residential Treatment Facility, Emotionally Disturbed Children

  NPD Authorized official

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

{
    "created_epoch": "1599782400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1599782400000",
    "number": "1073128492",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9556 LANGDON AVE",
            "city": "NORTH HILLS",
            "state": "CA",
            "postal_code": "913432103",
            "telephone_number": "310-930-0199"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4200 CRESCENT ROCK LN",
            "city": "BAKERSFIELD",
            "state": "CA",
            "postal_code": "933112860",
            "telephone_number": "310-930-0199",
            "fax_number": "818-475-1914"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CAMPBELL",
        "first_name": "SAMUEL",
        "name_suffix": "Jr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-09-11",
        "last_updated": "2020-09-11",
        "certification_date": "2020-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "CA",
            "license": "157806092",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jessica Campbell
• Kimberly Ann Campbell, PT
• Lorraine Dome Campbell, PAC
• Megan Campbell
• Melissa Denise Campbell, RDHAP
• Erin Danielle Campise, LCSW
• Zelina Yasmin Campista Chavez
• Ildefonso Timple Campomanes III, P.T.
• Jose Armando Campos Bustamante
• Domitilo Campos Espinoza

• Emotionally Disturbed Childrens' Residential Treatment Facility in Bakersfield, CA
• Providers in Bakersfield, CA by specialty
• Emotionally Disturbed Childrens' Residential Treatment Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.