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General NPI Number Information
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NPI Number | 1043784069
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Entity Type | Organization
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Legal Business Name | CITADEL SHORT TERM SPECIALTY TREATMENT PROGRAMS
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Dates
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Enumeration Date | 01/12/2019
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Last Update Date | 04/21/2022
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Provider Practice Location Address
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Address Line | 568 N MOUNTAIN VIEW AVE
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City | SAN BERNARDINO
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State | CA
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Zip | 92401-1231
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Country | US
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Telephone | 909-992-0929
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Fax |
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Provider Business Mailing Address
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Address Line | 568 N MOUNTAIN VIEW AVE
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City | SAN BERNARDINO
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State | CA
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Zip | 92401-1231
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Country | US
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Telephone | 909-992-0929
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | ANNETTE PUNIMATA
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Credential |
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Telephone | 909-992-0929
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 3245S0500X
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Taxonomy Name | Children's Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number |
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License Number State |
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