Moreno Valley CMHC

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

MORENO VALLEY CMHC

Doing business as

Eleos Cognitive Center

Practice address

23180 Hemlock Ave Ste 100
Moreno Valley, CA 92557-8001

Phone

(951) 500-1152

NPI assigned

Jan 9, 2019

Last updated

Feb 7, 2023By 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

Dr. Joel A Pengson, MDNPI 1720018237

Title

Ceo

Phone

(951) 500-1152

Specialties & licenses 9

Addresses

Other names 1

• Eleos Cognitive Center Doing business as

Medicare fee-for-service enrollment

Enrolled in CA2 enrollments

Enrollment records 2

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1710450036. Details of each certification follow.

• CCN 054681 Community mental health center · Active · Name & address match · Details

Community mental health center certification: CCN 054681

Legal name

MORENO VALLEY CMHC

Certification status

Active

Provider type (POS)

Community mental health center

Participating since

Nov 15, 2023

Last certification

Nov 15, 2023

Ownership / control type

For profit – individual

Facility address

23180 Hemlock Avenue, Suite 100
Moreno Valley, CA 92557

Locations

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.

• Joel A Pengson, MD

  • Internal Medicine Physician
  • Moreno Valley, CA
  • NPI 1720018237
  Medicare reassignment NPD Authorized official
• Venugopal Depala, MD

  • Psychiatry Physician
  • Temecula, CA
  • NPI 1699877480
  Medicare reassignment NPD
• Mayra E Garcia

  • Clinical Social Worker
  • San Bernardino, CA
  • NPI 1386044709
  Medicare reassignment NPD
• Allan Concepcion Elarmo, NP

  • Family Nurse Practitioner
  • Moreno Valley, CA
  • NPI 1659705689
  NPD (past)

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

{
    "created_epoch": "1546992000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1675728000000",
    "number": "1710450036",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 220",
            "city": "MORENO VALLEY",
            "state": "CA",
            "postal_code": "925560220",
            "telephone_number": "951-266-9880",
            "fax_number": "951-289-7964"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23180 HEMLOCK AVE STE 100",
            "city": "MORENO VALLEY",
            "state": "CA",
            "postal_code": "925578001",
            "telephone_number": "951-500-1152"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MORENO VALLEY CMHC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-01-09",
        "last_updated": "2023-02-07",
        "certification_date": "2023-02-07",
        "status": "A",
        "authorized_official_last_name": "PENGSON",
        "authorized_official_first_name": "JOEL",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "951-500-1152",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1835P1200X",
            "taxonomy_group": "",
            "desc": "Pharmacist, Pharmacotherapy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP1700X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Perinatal",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1835P0018X",
            "taxonomy_group": "",
            "desc": "Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225XM0800X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "175T00000X",
            "taxonomy_group": "",
            "desc": "Peer Specialist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Eleos Cognitive Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Stephanie Rae Morales, PHARMD
• Vivien-Leigh Morales
• Payal Morari, DO
• Daniel Morcos, MD
• Moreno Valley Children's Interagency Program
• Moreno Valley Community Hospital (Valley Health System)
• Moreno Valley Community Medical Group
• Moreno Valley Dental Center
• Moreno Valley Dialysis Center
• Moreno Valley Imaging, L.L.C.

• Mental Health Clinic/Center (Including Community Mental Health Center) in Moreno Valley, CA
• Providers in Moreno Valley, CA by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.