Wood Dragon Inn LLC

Primary specialty

Psychiatric Residential Treatment FacilityTaxonomy code 323P00000X

Legal business name

WOOD DRAGON INN LLC

Doing business as

Mental Health Residential

Practice address

53295 Oates Lane
Idyllwild, CA 92549

Phone

(800) 750-2613

NPI assigned

Feb 23, 2024

Last updated

Aug 12, 2024By 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

Tyler Penrod

Title

Consultant

Phone

(305) 900-4715

Specialties & licenses 1

Addresses

Other names 1

• Mental Health Residential Doing business as

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

{
    "created_epoch": "1708646400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1723420800000",
    "number": "1821854290",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2224 GREENLEAF ST",
            "city": "SANTA ANA",
            "state": "CA",
            "postal_code": "927062536"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "53295 OATES LANE",
            "city": "IDYLLWILD",
            "state": "CA",
            "postal_code": "92549",
            "telephone_number": "800-750-2613"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WOOD DRAGON INN LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-02-23",
        "last_updated": "2024-08-12",
        "certification_date": "2024-08-12",
        "status": "A",
        "authorized_official_last_name": "PENROD",
        "authorized_official_first_name": "TYLER",
        "authorized_official_title_or_position": "CONSULTANT",
        "authorized_official_telephone_number": "305-900-4715"
    },
    "taxonomies": [
        {
            "code": "323P00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Residential Treatment Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mental Health Residential",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Mental Health Residential",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Tierra Wheatley, DACM, L.AC
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• William Whitman, P. T.
• Cara Lynn Wilkerson, LMFT
• Robyn Winks, LMFT

• Psychiatric Residential Treatment Facility in Idyllwild, CA
• Providers in Idyllwild, CA by specialty
• Psychiatric Residential Treatment Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2024; 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.