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General NPI Number Information
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NPI Number | 1306534797
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Entity Type | Organization
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Legal Business Name | CORRECTIONAL HEALTH TREATMENT CENTERS INC
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Dates
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Enumeration Date | 04/25/2023
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Last Update Date | 02/05/2026
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Provider Practice Location Address
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Address Line | 473 S CARNEGIE DR STE 200
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City | SAN BERNARDINO
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State | CA
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Zip | 92408-4201
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Country | US
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Telephone | 626-223-5071
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Fax |
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Provider Business Mailing Address
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Address Line | 473 S CARNEGIE DR STE 200
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City | SAN BERNARDINO
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State | CA
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Zip | 92408-4201
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Country | US
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Telephone | 888-506-5609
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Fax | 909-884-0388
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Authorized Official
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Title or Position | MANAGING DIRECTOR
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Name | MR. KELLY MARTIN
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Credential | MANAGING DIRECTOR
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Telephone | 800-842-1598
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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 | 385H00000X
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Taxonomy Name | Respite Care
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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 | 251X00000X
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Taxonomy Name | Supports Brokerage Agency
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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 | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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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 | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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