Healthcare Provider Details

I. General information

NPI: 1306534797
Provider Name (Legal Business Name): CORRECTIONAL HEALTH TREATMENT CENTERS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2023
Last Update Date: 03/27/2026
Certification Date: 03/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

473 S CARNEGIE DR STE 200
SAN BERNARDINO CA
92408-4201
US

IV. Provider business mailing address

473 S CARNEGIE DR STE 200
SAN BERNARDINO CA
92408-4201
US

V. Phone/Fax

Practice location:
  • Phone: 888-506-5609
  • Fax: 909-884-0388
Mailing address:
  • Phone: 888-506-5609
  • Fax: 909-884-0388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: MR. KELLY MARTIN
Title or Position: MANAGING DIRECTOR
Credential: MANAGING DIRECTOR
Phone: 800-842-1598