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General NPI Number Information
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NPI Number | 1619305760
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Entity Type | Organization
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Legal Business Name | MENTAL HEALTH SERVICES
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Dates
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Enumeration Date | 10/29/2013
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Last Update Date | 10/29/2013
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Provider Practice Location Address
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Address Line | 5394 SIERRA RD 1874 BUSINESS CENTER DR SAN BERNARDINO CA 92408
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City | SAN BERNARDINO
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State | CA
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Zip | 92407-3241
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Country | US
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Telephone | 909-918-7241
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Fax |
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Provider Business Mailing Address
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Address Line | 5394 SIERRA RD
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City | SAN BERNARDINO
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State | CA
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Zip | 92407-3241
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Country | US
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Telephone | 909-918-7241
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Fax |
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Authorized Official
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Title or Position | DRUG AND ALCOHOL COUNSELOR
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Name | MRS. VICKI MICHELLE HOBSON
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Credential |
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Telephone | 909-918-7241
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 276400000X
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Taxonomy Name | Substance Use Disorder Rehabilitation Hospital Unit
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License Number |
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License Number State |
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