NPIMap

Organization Active NPI

County of San Bernardino

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Hesperia, CA
National Provider Identifier
1154539765
Registry record updated Sep 24, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
License
ZZZ74743Z Issued in CA
Legal business name
COUNTY OF SAN BERNARDINO
Practice address
14628 Main Street
Hesperia, CA 92345
Phone
(909) 382-3080
Fax
(909) 382-3105
NPI assigned
May 18, 2007
Organization subpart
Yes
Parent organization
DEPARTMENT OF BEHAVIORAL HEALTHAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 24, 2009

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
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X ZZZ74743Z CA Primary

Addresses

Primary practice location

14628 Main Street
Hesperia, CA 92345

Mailing address

268 W Hospitality Lane
Suite 400
San Bernardino, CA 92415-0026
Phone (909) 382-3080

Other names 1

  • Main Street Hesperia Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031209000420 CA Part B Supplier - Clinic/Group Practice 3870499130 Receives reassigned benefits from 233 practitioners
35 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Needles, CA; Victorville, CA; San Bernardino, CA; Rialto, CA; Ontario, CA; Hesperia, CA; Fontana, CA; Colton, CA…

Other NPIs on the same Medicare enrollment 31

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 31

National Provider Directory

National Provider Directory
Part of
San Bernardino County D

Locations

14628 Main St
Hesperia, CA 92345
Phone (760) 244-0576

NPI Registry JSON

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

{
    "created_epoch": "1179446400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1253750400000",
    "number": "1154539765",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "268 W HOSPITALITY LANE",
            "address_2": "SUITE 400",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924150026",
            "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": "14628 MAIN STREET",
            "city": "HESPERIA",
            "state": "CA",
            "postal_code": "92345",
            "telephone_number": "909-382-3080",
            "fax_number": "909-382-3105"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTY OF SAN BERNARDINO",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DEPARTMENT OF BEHAVIORAL HEALTH",
        "enumeration_date": "2007-05-18",
        "last_updated": "2009-09-24",
        "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": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "CA",
            "license": "ZZZ74743Z",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Main Street Hesperia Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hesperia, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2009; 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.