Hacienda Village

Primary specialty

Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X

License

336411358 Issued in CA

Legal business name

HACIENDA VILLAGE

Practice address

1435 University Ave
Riverside, CA 92507-4466

Phone

(951) 683-4056

Fax

(951) 788-5352

NPI assigned

Jan 29, 2009

Last updated

Jan 29, 2009By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Shawn S Shirazi

Title

Chief Executive Officer

Phone

(951) 683-4056

Specialties & licenses 1

Addresses

Tax ID family

Hacienda Village2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Redwood Grove

  • Assisted Living Facility (Mental Illness)
  • Tujunga, CA
  • NPI 1760884555
  NPD tax ID

Locations

Practitioners 1

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.

• Krishan S Krishna, MD

  • Cardiovascular Disease Physician
  • Anaheim, CA
  • NPI 1922111731
  NPD (past)

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

{
    "created_epoch": "1233187200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1233187200000",
    "number": "1255579215",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1435 UNIVERSITY AVE",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925074466",
            "telephone_number": "951-683-4056",
            "fax_number": "951-788-5352"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1435 UNIVERSITY AVE",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925074466",
            "telephone_number": "951-683-4056",
            "fax_number": "951-788-5352"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HACIENDA VILLAGE",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-01-29",
        "last_updated": "2009-01-29",
        "status": "A",
        "authorized_official_last_name": "SHIRAZI",
        "authorized_official_first_name": "SHAWN",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "951-683-4056"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "CA",
            "license": "336411358",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• John Richard Haalboom Jr.
• Gina Habeeb
• Dina Habib
• Hafsa Habib, OTD
• Miral Habib
• Irelynn Hacker
• Daniel L. Hackett, MD
• Ahmed Haddad
• Elias Haddad, M.D.
• Nadim S. Haddad, MD

• Adult Mental Health Clinic/Center in Riverside, CA
• Providers in Riverside, CA by specialty
• Adult Mental Health Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2009; 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.