NPIMap

Organization Active NPI

Varsity Team, Incorporated

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Brawley, CA
National Provider Identifier
1245814151
Registry record updated May 6, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X
Legal business name
VARSITY TEAM, INCORPORATED
Practice address
602 S 18TH St
Brawley, CA 92227-2859
Phone
(760) 623-7131
Fax
(619) 362-9532
NPI assigned
May 6, 2021
Last updated
May 6, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 6, 2021

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

Authorized official

Name
Drew Dahlstedt
Title
Cfo/Coo
Phone
(619) 694-6809

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X
Community/Behavioral Health Agency 251S00000X
Adolescent and Children Mental Health Clinic/Center 261QM0855X
Emotionally Disturbed Childrens' Residential Treatment Facility 322D00000X Primary
Psychiatric Residential Treatment Facility 323P00000X
Children's Substance Abuse Rehabilitation Facility 3245S0500X

Addresses

Primary practice location

602 S 18TH St
Brawley, CA 92227-2859

Mailing address

PO Box 26633
San Diego, CA 92196-0633
Phone (619) 694-6809

Other practice location 1

8745 Bennington St
San Diego, CA 92126-3221
Phone (858) 860-5332

Other practice location 2

1305 S La Brucherie Rd
El Centro, CA 92243-9518
Phone (760) 339-4992

Other practice location 3

3027 Fleming Dr
San Diego, CA 92139-3714
Phone (619) 512-1552

National Provider Directory

National Provider Directory
Tax ID family
Varsity Team 14 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 8

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": "1620259200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1620259200000",
    "number": "1245814151",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 26633",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921960633",
            "telephone_number": "619-694-6809",
            "fax_number": "619-362-9532"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "602 S 18TH ST",
            "city": "BRAWLEY",
            "state": "CA",
            "postal_code": "922272859",
            "telephone_number": "760-623-7131",
            "fax_number": "619-362-9532"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8745 Bennington St",
            "address_purpose": "LOCATION",
            "city": "San Diego",
            "state": "CA",
            "postal_code": "921263221",
            "country_code": "US",
            "telephone_number": "858-860-5332",
            "fax_number": "619-362-9532",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1305 S La Brucherie Rd",
            "address_purpose": "LOCATION",
            "city": "El Centro",
            "state": "CA",
            "postal_code": "922439518",
            "country_code": "US",
            "telephone_number": "760-339-4992",
            "fax_number": "619-362-9532",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3027 Fleming Dr",
            "address_purpose": "LOCATION",
            "city": "San Diego",
            "state": "CA",
            "postal_code": "921393714",
            "country_code": "US",
            "telephone_number": "619-512-1552",
            "fax_number": "619-362-9532",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "VARSITY TEAM, INCORPORATED",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-06",
        "last_updated": "2021-05-06",
        "certification_date": "2021-05-06",
        "status": "A",
        "authorized_official_last_name": "DAHLSTEDT",
        "authorized_official_first_name": "DREW",
        "authorized_official_title_or_position": "CFO/COO",
        "authorized_official_telephone_number": "619-694-6809"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "323P00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Residential Treatment Facility",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3245S0500X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility, Substance Abuse Treatment, Children",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brawley, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2021; 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.