1699976597 NPI number — CHILDREN'S CRISIS RESPONSE TEAM MORONGO BASIN

Table of content: MELISSA RAE KIRN PT (NPI 1245566454)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699976597 NPI number — CHILDREN'S CRISIS RESPONSE TEAM MORONGO BASIN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHILDREN'S CRISIS RESPONSE TEAM MORONGO BASIN
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1699976597
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/13/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
268 W. HOSPITALITY LANE
Provider Second Line Business Mailing Address:
SUITE 400
Provider Business Mailing Address City Name:
SAN BERNARDINO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92415-0026
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-382-3080
Provider Business Mailing Address Fax Number:
909-382-3105

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
56357 PIMA TRAIL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YUCCA VALLEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92284
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-382-3080
Provider Business Practice Location Address Fax Number:
909-382-3105
Provider Enumeration Date:
05/29/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DAY
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
J
Authorized Official Title or Position:
INFORMATION TECHNOLOGY MANAGER
Authorized Official Telephone Number:
909-388-0570

Provider Taxonomy Codes

  • Taxonomy code: 261QM0855X , with the licence number:  ZZZ74743Z , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3600036DG . This is a "MEDICAL PROVIDER NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com