NPIMap

Organization Active NPI

Promesa Behavioral Health

  • Mental Illness Community Based Residential Treatment Facility
  • Fresno, CA
National Provider Identifier
1962997221
Registry record updated Sep 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X
License
107201149 Issued in CA
Legal business name
PROMESA BEHAVIORAL HEALTH
Practice address
4291 N Millbrook Ave
Fresno, CA 93726
Phone
(559) 439-5437
NPI assigned
Jun 28, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 5, 2024

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

Authorized official

Name
Amanda Irene Reed, LMFT
Title
Director
Phone
(559) 439-5437

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Illness Community Based Residential Treatment Facility 320800000X 107201149 CA Primary

Addresses

Primary practice location

4291 N Millbrook Ave
Fresno, CA 93726

Mailing address

7120 N Marks Ave Ste 110
Fresno, CA 93711-0268
Phone (559) 341-2394

Other identifiers 1

IdentifierTypeStateIssuer
101044MedicaidCA

Other names 1

  • PROMESA BEHAVIORAL HEALTH- Millbrook Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Promesa Behavioral Health FCHN39 organizations share this tax ID, including this one

Other organizations with this tax ID 38

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

View all 38

Locations

4291 N Millbrook Ave
Fresno, CA 93726
Phone (559) 224-7967

Practitioners & affiliated clinicians

Practitioners 43

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

View all 43

NPI Registry JSON

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

{
    "created_epoch": "1530144000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1725494400000",
    "number": "1962997221",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7120 N MARKS AVE STE 110",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937110268",
            "telephone_number": "559-341-2394"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4291 N MILLBROOK AVE",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "93726",
            "telephone_number": "559-439-5437"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROMESA BEHAVIORAL HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-06-28",
        "last_updated": "2024-09-05",
        "certification_date": "2024-09-05",
        "status": "A",
        "authorized_official_last_name": "REED",
        "authorized_official_first_name": "AMANDA",
        "authorized_official_middle_name": "IRENE",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "559-439-5437",
        "authorized_official_credential": "LMFT"
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "CA",
            "license": "107201149",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "101044",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PROMESA BEHAVIORAL HEALTH- Millbrook",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fresno, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 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.