NPIMap

Organization Active NPI

County of San Bernardino

  • Adult Mental Health Clinic/Center
  • Apple Valley, CA
National Provider Identifier
1902010887
Registry record updated Apr 18, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X
License
ZZZ74743Z Issued in CA
Legal business name
COUNTY OF SAN BERNARDINO
Practice address
18818 Hwy 18
Apple Valley, CA 92307-0009
Phone
(760) 995-8813
Fax
(760) 995-8929
NPI assigned
May 9, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 18, 2023

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

Authorized official

Name
Mr. Mark Edward Thomas, LMFT
Title
Mental Health Clinic Supervisor
Phone
(951) 662-3730

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Mental Health Clinic/Center 261QM0850X ZZZ74743Z CA Primary

Addresses

Primary practice location

18818 Hwy 18
Apple Valley, CA 92307-0009

Mailing address

18818 Hwy 18
Apple Valley, CA 92307-0009
Phone (760) 995-8813

Other identifiers 1

IdentifierTypeStateIssuer
36DMMedicaidCA

Other names 1

  • DAAS AGE WISE Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031209000420 CA Part B Supplier - Clinic/Group Practice 3870499130 Receives reassigned benefits from 233 practitioners
35 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Needles, CA; Victorville, CA; San Bernardino, CA; Rialto, CA; Ontario, CA; Hesperia, CA; Fontana, CA; Colton, CA…

Other NPIs on the same Medicare enrollment 31

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 31

National Provider Directory

National Provider Directory
Tax ID family
San Bernardino County D142 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

11951 Hesperia Rd
Hesperia, CA 92345
Phone (760) 956-2345

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1178668800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1681776000000",
    "number": "1902010887",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18818 HWY 18",
            "city": "APPLE VALLEY",
            "state": "CA",
            "postal_code": "923070009",
            "telephone_number": "760-995-8813",
            "fax_number": "760-995-8929"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18818 HWY 18",
            "city": "APPLE VALLEY",
            "state": "CA",
            "postal_code": "923070009",
            "telephone_number": "760-995-8813",
            "fax_number": "760-995-8929"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTY OF SAN BERNARDINO",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-09",
        "last_updated": "2023-04-18",
        "certification_date": "2023-04-18",
        "status": "A",
        "authorized_official_last_name": "THOMAS",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "EDWARD",
        "authorized_official_title_or_position": "MENTAL HEALTH CLINIC SUPERVISOR",
        "authorized_official_telephone_number": "951-662-3730",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LMFT"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "CA",
            "license": "ZZZ74743Z",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "36DM",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DAAS AGE WISE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Apple Valley, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.