MEDICARE: MENTAL HEALTH SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	276400000X	Substance Use Disorder Rehabilitation Hospital Unit

General Provider Information

NPI Number	:	1619305760
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MENTAL HEALTH SERVICES

Provider Business Mailing Address
First Line	:	5394 SIERRA RD
Second Line	:
City	:	SAN BERNARDINO
State	:	CA
Zip	:	92407-3241
Country	:	US
Telephone Number	:	909-918-7241
Fax Number	:

Provider Business Practice Location Address
First Line	:	5394 SIERRA RD
Second Line	:	1874 BUSINESS CENTER DR SAN BERNARDINO CA 92408
City	:	SAN BERNARDINO
State	:	CA
Zip	:	92407-3241
Country	:	US
Telephone Number	:	909-918-7241
Fax Number	:

Authorized Official
Title or Position	:	DRUG AND ALCOHOL COUNSELOR
Name	:	MRS. VICKI MICHELLE HOBSON
Credential	:
Telephone Number	:	909-918-7241

Provider Enumeration Date	:	10/29/2013
Last Update Date	:	10/29/2013

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