NPIMap

Organization Active NPI

Department of State Hospitals

  • Psychiatric Hospital
  • Norwalk, CA
National Provider Identifier
1265406565
Registry record updated Oct 19, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric HospitalTaxonomy code 283Q00000X
License
170000832 Issued in CA
Legal business name
DEPARTMENT OF STATE HOSPITALS
Practice address
11401 Bloomfield Ave
Norwalk, CA 90650-2015
Phone
(562) 863-7011
NPI assigned
Feb 14, 2006
Organization subpart
Yes
Parent organization
DEPARTMENT OF STATE HOSPITALSAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 19, 2021

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

Authorized official

Name
Guadalupe M Alonzo-Diaz
Title
Administrative Deputy Director
Phone
(916) 654-2655

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric Hospital 283Q00000X 170000832 CA Primary
Skilled Nursing Facility 314000000X 170000832 CA
Long Term Care Pharmacy 3336L0003X 170000832 CA

Addresses

Primary practice location

11401 Bloomfield Ave
Norwalk, CA 90650-2015

Mailing address

1215 O St # Ms -3
Sacramento, CA 95814-5804
Phone (916) 651-8906

Other names 1

  • Department of State Hospitals - Metropolitan Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20081031000305 CA Part B Supplier - Clinic/Group Practice 9638174238 Receives reassigned benefits from 751 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Atascadero, CA; Coalinga, CA; Napa, CA; Norwalk, CA; Patton, CA
O20090129000452 CA Part A Provider - Hospital 9638174238 Practice locations: Norwalk, CA

Hospital certification: CCN 054133

Legal name
DEPARTMENT OF STATE HOSPITALS
Doing business as
METROPOLITAN STATE HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Psychiatric
Participating since
Nov 30, 1993
Last certification
May 19, 2023
Beds
1,106 (46 certified)
Ownership / control type
State
Organization structure
OtherNon-profit
Enrollment address
11401 Bloomfield Ave
Norwalk, CA 90650-2015
Main/Primary Hospital Location
Hospital subgroups
Psychiatric

Other NPIs with the same Medicare PAC ID 4

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 4

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Dept of State Hospitals - Metropolitan - PsyCCN 054133
Type
Psychiatric
Ownership
Government - State
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Tax ID family
Dept of State Hosp5 organizations share this tax ID, including this one
Part of
Dept of State Hosp

Other organizations with this tax ID 4

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

Locations

3102 E Highland Ave
Patton, CA 92369
Phone (909) 425-7000

Ownership & related parties

All disclosed owners & managing parties 6

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Wendy Ly Individual W-2 Managing Employee Oct 22, 2018
Glenn Fujii Individual W-2 Managing Employee Sep 24, 2014
Stephanie L Clendenin Individual Corporate DirectorChief Deputy Director Jan 7, 2015
Sean Hammer Individual Corporate DirectorDeputy Director Mar 18, 2022
Samantha Auduong Individual W-2 Managing EmployeeDelegated Official Mar 8, 2022
Department of State Hospitals Organization, Sacramento, CA Chain home office Operational/Managerial Control Jul 1, 2011 100%

Owners & managing parties with NPI records 4

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 3

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Patton State HospitalPatton, CA, CCN 05124E Hospital Operational/Managerial Control Oct 1, 1982
Napa State HospitalNapa, CA, CCN 054122 Hospital Operational/Managerial Control Jul 1, 2011
Atascadero State HospitalAtascadero, CA, CCN 05125E Hospital Operational/Managerial Control Oct 1, 1982

Owned or controlled facilities with NPI records 3

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 3

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 342

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

View all 342

NPI Registry JSON

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

{
    "created_epoch": "1139875200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1634601600000",
    "number": "1265406565",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1215 O ST # MS -3",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958145804",
            "telephone_number": "916-651-8906",
            "fax_number": "916-651-8908"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11401 BLOOMFIELD AVE",
            "city": "NORWALK",
            "state": "CA",
            "postal_code": "906502015",
            "telephone_number": "562-863-7011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEPARTMENT OF STATE HOSPITALS",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DEPARTMENT OF STATE HOSPITALS",
        "enumeration_date": "2006-02-14",
        "last_updated": "2021-10-19",
        "certification_date": "2021-10-19",
        "status": "A",
        "authorized_official_last_name": "ALONZO-DIAZ",
        "authorized_official_first_name": "GUADALUPE",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "ADMINISTRATIVE DEPUTY DIRECTOR",
        "authorized_official_telephone_number": "916-654-2655"
    },
    "taxonomies": [
        {
            "code": "283Q00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Hospital",
            "state": "CA",
            "license": "170000832",
            "primary": true
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "CA",
            "license": "170000832",
            "primary": false
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "CA",
            "license": "170000832",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Department of State Hospitals - Metropolitan",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Department of State Hospitals - Metropolitan",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Norwalk, CA

Sources for this page

Verify at the official NPI Registry.