FRESNO COUNTY APOLLO RESIDENTIAL PROG. (NPI# 1104978022) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1104978022 |
| Entity Type | Organization |
| Organization Name | FRESNO COUNTY APOLLO RESIDENTIAL PROG. |
| Practice Address |
205 N Blackstone Ave Fresno CA 93701-1914 |
| Practice Telephone | 5594980241 |
| Mailing Telephone | 5594980241 |
| Enumeration Date | 2007-01-18 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | GIANG T NGUYEN (DIRECTOR, FRESNO CO MENTAL HEALTH) |
| Authorized Official Telephone | 5592539180 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 323P00000X | Psychiatric Residential Treatment Facility | CA | Residential Treatment Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | COST CENTER | 2160 | 01 |
| Street Address |
205 N BLACKSTONE AVE |
| City | FRESNO |
| State | CA |
| Zip Code | 93701-1914 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760539993 | Lydia Janett Allen | Rehabilitation Practitioner | 205 N Blackstone Ave, Fresno, CA 93701-1914 | 2007-01-03 |
| 1437315819 | Sunday Osho Olusegun | Licensed Vocational Nurse | 205 N Blackstone Ave, Fresno, CA 93701-1914 | 2008-08-05 |
| 1043476534 | Eleanor Cantu Granados | Counselor | 205 N Blackstone Ave, Fresno, CA 93701-1914 | 2008-08-04 |
| 1518015007 | Maria C Urrutia | Rehabilitation Practitioner | 205 N Blackstone Ave, Fresno, CA 93701-1914 | 2007-01-08 |
| 1932257417 | Rosa E Negrete | Rehabilitation Practitioner | 205 N Blackstone Ave, Fresno, CA 93701-1914 | 2007-01-08 |
| 1487702262 | Kelly Johnson | Rehabilitation Practitioner | 205 N Blackstone Ave, Fresno, CA 93701-1914 | 2007-01-08 |
| 1417005273 | Mayra Luz Tienda | Rehabilitation Practitioner | 205 N Blackstone Ave, Fresno, CA 93701-1914 | 2007-01-08 |
| 1821146283 | Mary Ellen Perez | Rehabilitation Practitioner | 205 N Blackstone Ave, Fresno, CA 93701-1914 | 2007-01-08 |
| 1093862500 | Dutch Epperson | Rehabilitation Practitioner | 205 N Blackstone Ave, Fresno, CA 93701-1914 | 2007-01-05 |
| 1043367360 | Lillie Lois Johnson | Rehabilitation Practitioner | 205 N Blackstone Ave, Fresno, CA 93701-1914 | 2007-01-05 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134740244 | Tamara Sue Stanic | Registered Nurse | 215 N. Fresno Street, Suite 370, Fresno, CA 93701 | 2020-04-29 |
| 1144849829 | Katelyn Nicole Van Leir | Student in an Organized Health Care Education/Training Program | Surabian Dental Care Center - Suite 2500, 290 N. Wayte Lane, Fresno, CA 93701 | 2020-04-13 |
| 1003445693 | Michelle Edwardson | Registered Nurse | 215 North Fresno Street, Suite 370, Fresno, CA 93701 | 2020-04-06 |
| 1184253924 | Patricia Calderon | Registered Nurse | 215 N. Fresno Street, Suite 230, Fresno, CA 93701 | 2020-04-03 |
| 1922637032 | Leticia Lopez | Registered Nurse | 215 N. Fresno Street, Suite 230, Fresno, CA 93701 | 2020-04-02 |
| 1275026585 | Yesenia Gonzalez | Nurse Practitioner | 311 Abby Street, Fresno, CA 93701 | 2018-06-11 |
| 1710474606 | Amanda Juarez | Dietitian, Registered | 215 N Fresno, Suite 370, Fresno, CA 93701 | 2018-04-17 |
| 1235650391 | Plastic Surgery Partners of Fresno Inc | Plastic Surgery | 215 N Fresno St, Ste 490, Fresno, CA 93701 | 2017-06-29 |
| 1205369790 | Amy Alagh | Student in an Organized Health Care Education/Training Program | 155 N Fresno Street, Fresno, CA 93701 | 2017-04-11 |
| 1922462159 | Henry Matthew Dunn | Student in an Organized Health Care Education/Training Program | Ucsf Fresno, 155 N. Fresno St., Department of Orthopaedic Surgery, Fresno, CA 93701 | 2016-04-13 |
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| Taxonomy Code | 323P00000X |
| Grouping | Residential Treatment Facilities |
| Classification | Psychiatric Residential Treatment Facility |
| A residential treatment facility (RTF) is a facility or distinct part of a facility that provides to children and adolescents, a total, twenty-four hour, therapeutically planned group living and learning situation where distinct and individualized psychotherapeutic interventions can take place. Residential treatment is a specific level of care to be differentiated from acute, intermediate, and long-term hospital care, when the least restrictive environment is maintained to allow for normalization of the patient’s surroundings. The RTF must be both physically and programmatically distinct if it is a part or subunit of a larger treatment program. An RTF is organized and professionally staffed to provide residential treatment of mental disorders to children and adolescents who have sufficient intellectual potential to respond to active treatment (that is, for whom it can reasonably be assumed that treatment of the mental disorder will result in an improved ability to function outside the RTF) for whom outpatient treatment, partial hospitalization or protected and structured environment is medically or psychologically necessary |
| Notes: Source: Champus Policy manual, Volume II, p. 6010.47M dated 9/12/94. Revision: Definition title revised 7/1/03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588148035 | Discovery Practice Management, Inc. | Psychiatric Residential Treatment Facility | 214 W Bluff Ave, Fresno, CA 93711-6930 | 2018-09-20 |
| 1891260576 | Sierra Meadows Behavioral Health | Psychiatric Residential Treatment Facility | 7065 N Maple Ave Ste 104, Fresno, CA 93720 | 2018-10-09 |
| 1487031472 | Crestwood Behavioral Health | Psychiatric Residential Treatment Facility | 4411 E Kings Canyon Rd, Fresno, CA 93702-3604 | 2015-04-29 |
| 1912159344 | Fresno County Behavioral Health | Psychiatric Residential Treatment Facility | 4411 E Kings Canyon Rd, Fresno, CA 93702-3604 | 2008-10-16 |
| 1558499749 | Fresno County Crestwood Fresno Bridge | Psychiatric Residential Treatment Facility | 153 N U St, Fresno, CA 93701-2438 | 2007-03-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679172720 | Meadows | Psychiatric Residential Treatment Facility | 6395 Meadows Ct, Malibu, CA 90265-1706 | 2020-10-20 |
| 1912506064 | Point Dume | Psychiatric Residential Treatment Facility | 29149 Cliffside Dr, Malibu, CA 90265-4215 | 2020-10-20 |
| 1275132326 | Beach House | Psychiatric Residential Treatment Facility | 29245 Cliffside Dr, Malibu, CA 90265-4268 | 2020-10-20 |
| 1376159566 | 3855 Brunston LLC | Psychiatric Residential Treatment Facility | 3855 Brunston Ct, Westlake Village, CA 91362-5130 | 2020-09-22 |
| 1649884909 | Montage Recovery Ca LLC | Psychiatric Residential Treatment Facility | 2890 Kana Dume, Malibu, CA 90265 | 2020-09-03 |
| 1245844596 | Montage Recovery California | Psychiatric Residential Treatment Facility | 15367 Valley Vista Blvd, Sherman Oaks, CA 91403 | 2020-09-03 |
| 1063024644 | Crownview Psychiatric Institute | Psychiatric Residential Treatment Facility | 1110 Camino Del Sol Cir, Carlsbad, CA 92008-3509 | 2020-08-17 |
| 1215545652 | Elevation Behavioral Health | Psychiatric Residential Treatment Facility | 3836 Kanan Rd, Agoura Hills, CA 91301-3237 | 2020-07-22 |
| 1053929273 | Montage Recovery Solutions | Psychiatric Residential Treatment Facility | 17801 Twilight Ln, Encino, CA 91316-4330 | 2020-07-14 |
| 1225646441 | Montage Recovery Solutions | Psychiatric Residential Treatment Facility | 2900 S Kanan Dume Rd, Malibu, CA 90265-2792 | 2020-07-14 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.