Mental Health Management I, Inc.

Primary specialty

Psychiatric Residential Treatment FacilityTaxonomy code 323P00000X

License

02089023 Issued in CA

Legal business name

MENTAL HEALTH MANAGEMENT I, INC.

Practice address

655 Canyon Road
Novato, CA 94947

Phone

(415) 892-1628

Fax

(415) 892-8624

NPI assigned

Dec 14, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Richard Paul Evatz, L.C.S.W.

Title

Executive Director

Phone

(415) 892-1628

Specialties & licenses 1

Addresses

Other names 1

• Canyon Manor Doing business as

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

{
    "created_epoch": "1166054400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1881756401",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "655 CANYON ROAD",
            "city": "NOVATO",
            "state": "CA",
            "postal_code": "94947",
            "telephone_number": "415-892-1628",
            "fax_number": "415-892-8624"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "655 CANYON ROAD",
            "city": "NOVATO",
            "state": "CA",
            "postal_code": "94947",
            "telephone_number": "415-892-1628",
            "fax_number": "415-892-8624"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MENTAL HEALTH MANAGEMENT I, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-14",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "EVATZ",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "PAUL",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "415-892-1628",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "L.C.S.W."
    },
    "taxonomies": [
        {
            "code": "323P00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Residential Treatment Facility",
            "state": "CA",
            "license": "02089023",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Canyon Manor",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Psychiatric Residential Treatment Facility in Novato, CA
• Providers in Novato, 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 22, 2020; 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.