Jerry L. Pettis VA Memorial Hospital

Primary specialty

Psychiatric HospitalTaxonomy code 283Q00000X

License

219193 Issued in CA

Legal business name

JERRY L. PETTIS VA MEMORIAL HOSPITAL

Practice address

19845 San Luis Rey LN
Riverside, CA 92508-6494

Phone

(951) 653-7051

NPI assigned

Sep 22, 2007

Organization subpart

No

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

Authorized official

Name

Mr. Dean Stordahl

Title

Ceo

Phone

(909) 825-7084

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1190419200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1190419200000",
    "number": "1629264775",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19845 SAN LUIS REY LN",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925086494",
            "telephone_number": "951-653-7051"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19845 SAN LUIS REY LN",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925086494",
            "telephone_number": "951-653-7051"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JERRY L. PETTIS VA MEMORIAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-22",
        "last_updated": "2007-09-22",
        "status": "A",
        "authorized_official_last_name": "STORDAHL",
        "authorized_official_first_name": "DEAN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "909-825-7084",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "283Q00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Hospital",
            "state": "CA",
            "license": "219193",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joshua Jennings
• Jenny Sun Behavior Consultant LLC
• Lauren Mae Jensen, CF-RPE
• Jennifer Jerahian
• Jerri Middleton, LCSW
• Jerry Morana, Jr., DDS, a Professional Corporation
• Jennifer Quinci Jesser
• Jillian Jesser
• Jessica Duong,O.D.Inc.
• Heather Ann Jester

• Psychiatric Hospital in Riverside, CA
• Providers in Riverside, CA by specialty
• Psychiatric Hospital in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2007; 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.