LATOYA JACKSON (NPI# 1134467665) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1134467665 |
| Entity Type | Individual |
| Full Name | LATOYA JACKSON |
| Practice Address |
1053 N D St San Bernardino CA 92410-3521 |
| Practice Telephone | 9514365200 |
| Mailing Telephone | 9514365200 |
| Enumeration Date | 2013-01-17 |
| Last Update Date | 2013-01-17 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 322D00000X | Residential Treatment Facility, Emotionally Disturbed Children | Residential Treatment Facilities |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821697137 | Latoya Jackson | Homemaker | 480 Harmony Ln, Campbell, OH 44405-1213 | 2020-10-19 |
| 1659807477 | Latoya Jackson | Health Maintenance Organization | 5742 Jodphur Ct, Tallahassee, FL 32303-6748 | 2017-05-11 |
| 1538512017 | Latoya Jackson | Nurse Practitioner | 1500 N University Dr Ste 202, Coral Springs, FL 33071-6072 | 2016-07-19 |
| 1659764645 | Latoya Jackson | Driver | 4918 Neo Pkwy, Garfield Hts, OH 44128-3104 | 2015-03-15 |
| 1952510398 | Latoya Jackson | Counselor | 5041 New Centre Dr Ste 209, Wilmington, NC 28403-1624 | 2007-05-22 |
| 1528607827 | Latoya Monique Jackson | Behavior Technician | 17845 Ironwood Lane, Victorville, CA 92395-5166 | 2020-01-03 |
| 1669021192 | Latoya Jackson | Contractor | 2346 S Lynhurst Dr Ste 200, Indianapolis, IN 46241-5135 | 2019-09-07 |
| 1871066688 | Latoya Yvette Jackson | Occupational Therapy Assistant | 10400 S Roberts Rd, Palos Hills, IL 60465-1972 | 2019-01-03 |
| 1295207819 | Latoya Jackson | Marriage & Family Therapist | 4951 Central Ave, Monroe, LA 71203-6156 | 2018-12-20 |
| 1609327477 | Latoya Jackson | Counselor | 770 Woodlane Rd, Westampton, NJ 08060-3804 | 2016-10-17 |
| Street Address |
1053 N D ST |
| City | SAN BERNARDINO |
| State | CA |
| Zip Code | 92410-3521 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831207489 | Richard George Myatt | Marriage & Family Therapist | 1053 N D St, San Bernardino, CA 92410-3521 | 2006-08-25 |
| 1679103543 | Tracy Lynn Wainwright | Marriage & Family Therapist | 1053 N D St, San Bernardino, CA 92410-3521 | 2020-01-20 |
| 1174165468 | Elva Alejandra Silva | Counselor | 1053 N D St, San Bernardino, CA 92410-3521 | 2019-10-08 |
| 1477102796 | Kathryn Christensen | Marriage & Family Therapist | 1053 N D St, San Bernardino, CA 92410-3521 | 2019-09-09 |
| 1780232330 | Victor Samuel Ramirez | Marriage & Family Therapist | 1053 N D St, San Bernardino, CA 92410-3521 | 2019-08-27 |
| 1669029039 | Natalie Salas | Counselor | 1053 N D St, San Bernardino, CA 92410-3521 | 2019-08-21 |
| 1700431459 | Gerson Yestin Bravo | Marriage & Family Therapist | 1053 N D St, San Bernardino, CA 92410-3521 | 2019-08-08 |
| 1689226672 | Altanyce Brown | Counselor | 1053 N D St, San Bernardino, CA 92410-3521 | 2019-07-10 |
| 1679133235 | Jessica Jimenez | Counselor | 1053 N D St, San Bernardino, CA 92410-3521 | 2019-06-17 |
| 1922668854 | Beatrice A De La Cerra | Counselor | 1053 N D St, San Bernardino, CA 92410-3521 | 2019-06-13 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902303472 | Reina Elora Garcia | Student in an Organized Health Care Education/Training Program | 775 E Base Line St Spc 4, San Bernardino, CA 92410 | 2018-04-10 |
| 1558889881 | Salaunge Lopez | Non-emergency Medical Transport (VAN) | 25942 Baseline St Apt D203, San Bernardino, CA 92410 | 2017-09-07 |
| 1902328578 | Kelly Canady | Counselor | 1100 N. D St., San Bernardino, CA 92410 | 2017-07-14 |
| 1881058592 | Terron Thomas | Contractor | 445 South G, Unit B, San Bernardino, IN 92410 | 2016-04-08 |
| 1982064572 | Zachary Norton-martinez | Specialist/Technologist | 650 Del Rosa Dr, San Bernardino, CA 92410 | 2016-02-25 |
| 1003280934 | Brenda Boyle | Nurse Practitioner | 1455 East 3rd Street, San Bernardino, CA 92410 | 2015-11-16 |
| 1689045197 | Bryan Carter | Physician Assistant | 1455 E 3rd Street, San Bernardino, CA 92410 | 2015-10-09 |
| 1801270137 | Sac Health System | Clinic/Center | 250 South G Street, San Bernardino, CA 92410 | 2015-07-16 |
| 1467852269 | Wilson Dentistry, Inc. | Dentist | 1063 N. D St, San Bernardino, CA 92410 | 2014-08-28 |
| 1629405345 | Terrence John Forrester | Social Worker | 1455 E. 3rd St, San Bernardino, CA 92410 | 2013-09-27 |
| Find all providers in zip 92410 | ||||
| Taxonomy Code | 322D00000X |
| Grouping | Residential Treatment Facilities |
| Classification | Residential Treatment Facility, Emotionally Disturbed Children |
| A provider facility or distinct part of the organization which renders an interdisciplinary program of mental health treatment to individuals under 21 years of age who have persistent dysfunction in major life areas. The dysfunction is of an extent and pervasiveness that requires a protected and highly structured therapeutic environment. These organizations, or distinct part of organizations, exclude those that provide acute psychiatric care, partial hospitalization, group living, therapeutic schooling, primary diagnosis substance abuse disorder treatment, or primary diagnosis mental retardation or developmental disability treatment. |
| Notes: Source: U.S. Department of Defense Regulation 6010.8-R, Chapter 6. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134693153 | Citadel Community Care Facilities | Residential Treatment Facility, Emotionally Disturbed Children | 568 N Mountain View Ave, San Bernardino, CA 92401-1231 | 2019-01-12 |
| 1295279115 | Starshine Treatment Center | Residential Treatment Facility, Emotionally Disturbed Children | 1255 E Highland Ave Ste 217, San Bernardino, CA 92404-4653 | 2016-12-12 |
| 1457803645 | Starshine Treatment Center | Residential Treatment Facility, Emotionally Disturbed Children | 731 E 40th St, San Bernardino, CA 92404-1448 | 2016-11-04 |
| 1821540014 | Starshine Treatment Center | Residential Treatment Facility, Emotionally Disturbed Children | 2965 Garden Dr, San Bernardino, CA 92404-2525 | 2016-11-04 |
| 1770025926 | Starshine Treatment Center | Residential Treatment Facility, Emotionally Disturbed Children | 1004 E Lynwood Dr, San Bernardino, CA 92404-2545 | 2016-11-04 |
| 1770032534 | Lifeskills Development | Residential Treatment Facility, Emotionally Disturbed Children | 6095 Shepherd Dr, San Bernardino, CA 92407-2251 | 2016-09-22 |
| 1811343445 | Starshine Treatment Center, Inc | Residential Treatment Facility, Emotionally Disturbed Children | 460 S Stoddard Ave Ste 1&3, San Bernardino, CA 92401-2001 | 2016-05-12 |
| 1003368655 | Starshine Treatment Center Inc. | Residential Treatment Facility, Emotionally Disturbed Children | 1255 E Highland Ave, Ste 215, San Bernardino, CA 92404-6804 | 2016-10-31 |
| 1437499142 | Rey Vargas | Residential Treatment Facility, Emotionally Disturbed Children | 1053 N D St, San Bernardino, CA 92410-3521 | 2013-02-18 |
| 1366786782 | Victor Treatment Centers, Inc | Residential Treatment Facility, Emotionally Disturbed Children | 1053 N D St, San Bernardino, CA 92410-3521 | 2012-11-26 |
| Find all providers in SAN BERNARDINO | ||||
| City | SAN BERNARDINO |
| Zip Code | 92410 |
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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.