NPIMap

Organization Active NPI

Department of Behavioral Health, San Bernardino County Ca

  • Multi-Specialty Clinic/Center
  • Victorville, CA
National Provider Identifier
1124237425
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
License
ZZZ74743Z Issued in CA
Legal business name
DEPARTMENT OF BEHAVIORAL HEALTH, SAN BERNARDINO COUNTY CA
Practice address
12625 Hesperia Rd
Victorville, CA 92395-7720
Phone
(909) 382-3080
Fax
(909) 382-3105
NPI assigned
May 22, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mr. Michael J. Day
Title
Information Technology Manager
Phone
(909) 388-0570

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X ZZZ74743Z CA Primary

Addresses

Primary practice location

12625 Hesperia Rd
Victorville, CA 92395-7720

Mailing address

268 W Hospitality LN
Suite 400
San Bernardino, CA 92415-0001
Phone (909) 382-3080

Other identifiers 1

IdentifierTypeStateIssuer
36ACOtherCAMEDI-CAL PROVIDER NUMBER

Other names 1

  • Victorville Multidiagnosis Clinic Doing business as

National Provider Directory

National Provider Directory
Tax ID family
San Bernardino County D142 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1179792000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1124237425",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "268 W HOSPITALITY LN",
            "address_2": "SUITE 400",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924150001",
            "telephone_number": "909-382-3080",
            "fax_number": "909-382-3105"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12625 HESPERIA RD",
            "city": "VICTORVILLE",
            "state": "CA",
            "postal_code": "923957720",
            "telephone_number": "909-382-3080",
            "fax_number": "909-382-3105"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEPARTMENT OF BEHAVIORAL HEALTH, SAN BERNARDINO COUNTY CA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-22",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DAY",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "INFORMATION TECHNOLOGY MANAGER",
        "authorized_official_telephone_number": "909-388-0570",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "CA",
            "license": "ZZZ74743Z",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDI-CAL PROVIDER NUMBER",
            "identifier": "36AC",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Victorville Multidiagnosis Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Victorville, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 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.