NPIMap

Organization Active NPI

Purposely Chosen, Inc.

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • San Bernardino, CA
National Provider Identifier
1902401623
Registry record updated Dec 1, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X
Legal business name
PURPOSELY CHOSEN, INC.
Practice address
2248 Sheridan Rd
San Bernardino, CA 92407-2444
Phone
(909) 473-1700
Fax
(760) 302-7607
NPI assigned
Dec 1, 2020
Organization subpart
Yes
Parent organization
PURPOSELY CHOSEN, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 1, 2020

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

Authorized official

Name
Dretona Tenese Maddox, RN, PHN, LCSW
Title
Executive Director
Phone
(909) 471-0697

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emotionally Disturbed Childrens' Residential Treatment Facility 322D00000X Primary

Addresses

Primary practice location

2248 Sheridan Rd
San Bernardino, CA 92407-2444

Mailing address

1410 3Rd St Ste 2
Riverside, CA 92507-3454
Phone (909) 471-0697

Other names 1

  • Born for Nia Maternity Home - San Bernardino Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Purposely Chosen Inc3 organizations share this tax ID, including this one
Part of
Purposely Chosen Inc

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 4

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": "1606780800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1606780800000",
    "number": "1902401623",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1410 3RD ST STE 2",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925073454",
            "telephone_number": "909-471-0697",
            "fax_number": "760-302-7607"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2248 SHERIDAN RD",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924072444",
            "telephone_number": "909-473-1700",
            "fax_number": "760-302-7607"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PURPOSELY CHOSEN, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PURPOSELY CHOSEN, INC.",
        "enumeration_date": "2020-12-01",
        "last_updated": "2020-12-01",
        "certification_date": "2020-12-01",
        "status": "A",
        "authorized_official_last_name": "MADDOX",
        "authorized_official_first_name": "DRETONA",
        "authorized_official_middle_name": "TENESE",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "909-471-0697",
        "authorized_official_credential": "RN, PHN, LCSW"
    },
    "taxonomies": [
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Born for Nia Maternity Home - San Bernardino",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in San Bernardino, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 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.