NPIMap

Organization Active NPI

Kaiser Foundation Hospitals

Doing business as Kaiser Foundation Hospital Chem Dependency Recovery

  • Substance Abuse Rehabilitation Facility
  • Fontana, CA
National Provider Identifier
1306991278
Registry record updated Apr 20, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X
License
240000159 Issued in CA
Legal business name
KAISER FOUNDATION HOSPITALS
Doing business as
Kaiser Foundation Hospital Chem Dependency Recovery
Practice address
17046 Marygold Ave
Fontana, CA 92335-1706
Phone
(909) 427-5128
NPI assigned
Jan 23, 2007
Last updated
Apr 20, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 20, 2021

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

Authorized official

Name
Ruth Counts, MHA, RN, CPHQ
Title
Interim Director Arl
Phone
(626) 405-3676

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Abuse Rehabilitation Facility 324500000X 240000159 CA Primary

Addresses

Primary practice location

17046 Marygold Ave
Fontana, CA 92335-1706

Mailing address

17046 Marygold Ave
Fontana, CA 92335-1706
Phone (909) 427-5128

Other names 1

  • Kaiser Foundation Hospital Chem Dependency Recovery Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondingg Health Information Exchange (HIE)

National Provider Directory

National Provider Directory
Tax ID family
Kaiser Foundation Hosp Phcy186 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Locations

17046 Marygold Ave
Fontana, CA 92335
Phone (909) 427-5128

Practitioners & affiliated clinicians

Practitioners 4

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": "1169510400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1618876800000",
    "number": "1306991278",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17046 MARYGOLD AVE",
            "city": "FONTANA",
            "state": "CA",
            "postal_code": "923351706",
            "telephone_number": "909-427-5128"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17046 MARYGOLD AVE",
            "city": "FONTANA",
            "state": "CA",
            "postal_code": "923351706",
            "telephone_number": "909-427-5128"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KAISER FOUNDATION HOSPITALS",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-23",
        "last_updated": "2021-04-20",
        "certification_date": "2021-04-20",
        "status": "A",
        "authorized_official_last_name": "COUNTS",
        "authorized_official_first_name": "RUTH",
        "authorized_official_title_or_position": "INTERIM DIRECTOR ARL",
        "authorized_official_telephone_number": "626-405-3676",
        "authorized_official_credential": "MHA, RN, CPHQ"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "CA",
            "license": "240000159",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondingg",
            "affiliation": "N",
            "endpointDescription": "Carequality",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "17046 Marygold Ave",
            "city": "Fontana",
            "state": "CA",
            "country_code": "US",
            "postal_code": "923351706",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Kaiser Foundation Hospital Chem Dependency Recovery",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Kaiser Foundation Hospital Chem Dependency Recovery",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fontana, CA

Sources for this page

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