Iampurpose Wellness Center

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

IAMPURPOSE WELLNESS CENTER

Practice address

1410 3Rd St Ste 2
Riverside, CA 92507-3454

Phone

(909) 471-0697

Fax

(951) 405-4476

NPI assigned

Nov 18, 2020

Organization subpart

No

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

Authorized official

Name

Mrs. Dretona T. Maddox, RN, PHN, LCSWNPI 1417083643

Title

Nurse Social Work Practitioner

Phone

(909) 471-0697

Specialties & licenses 1

Addresses

Other names 1

• Dretona T. Maddox, Licensed Clinical Social Worker Other name

Locations

Practitioners 1

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

• Dretona Tenese Maddox, RN, PHN, LCSW

  • Clinical Social Worker
  • Riverside, CA
  • NPI 1417083643
  NPD Authorized official

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

{
    "created_epoch": "1605657600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1605830400000",
    "number": "1245833524",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1410 3RD ST STE 2",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925073454",
            "telephone_number": "909-471-0697",
            "fax_number": "951-405-4476"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1410 3RD ST STE 2",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925073454",
            "telephone_number": "909-471-0697",
            "fax_number": "951-405-4476"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IAMPURPOSE WELLNESS CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-11-18",
        "last_updated": "2020-11-20",
        "certification_date": "2020-11-20",
        "status": "A",
        "authorized_official_last_name": "MADDOX",
        "authorized_official_first_name": "DRETONA",
        "authorized_official_middle_name": "T.",
        "authorized_official_title_or_position": "NURSE SOCIAL WORK PRACTITIONER",
        "authorized_official_telephone_number": "909-471-0697",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "RN, PHN, LCSW"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dretona T. Maddox, Licensed Clinical Social Worker",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• John Sup Hyun, PHARM. D.
• Suzanne Hyun, M.D.
• I.E. DME Inc.
• I&E Nutrition Services Inc
• I4H Pharmacy LLC
• David C. Ianacone, MD
• Tyretel Iancu, DPT
• Cynthia Ibanez, NONE
• Julius Alfred Ibanez, M.D.
• Nancy Lisette Ibanez

• Community/Behavioral Health Agency in Riverside, CA
• Providers in Riverside, CA by specialty
• Community/Behavioral Health Agency in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 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.