N/A (NPI# 1194055749) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1194055749 |
| Entity Type | Organization |
| Organization Name | N/A |
| Practice Address |
4051 Lone Tree Way Ste C Antioch CA 94531-6204 |
| Mailing Address |
1869 San Andres Dr Pittsburg CA 94565-7651 |
| Practice Telephone | 9257572900 |
| Mailing Telephone | 9254585124 |
| Enumeration Date | 2010-01-04 |
| Last Update Date | 2010-01-04 |
| Authorized Official Name | MR. KEVIN ROLAND MARTIN (PHLEBOTOMIST) |
| Authorized Official Telephone | 9254585124 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 251S00000X | Community/Behavioral Health | 246RP1900X | CA | Agencies |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | CA | 93015226E48032 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811428980 | N/a | Nurse Practitioner | 6045 Sw 162nd Ave, Miami, FL 33193-5805 | 2017-03-21 |
| 1346783776 | N/a | Exclusive Provider Organization | Av. Tecnologico 183, Nuevo Laredo, TAMAULIPAS 88275 | 2016-12-03 |
| 1871953216 | N/a | Community/Behavioral Health | 1203 Saint Lawrence Ave, Beloit, WI 53511-5067 | 2016-02-27 |
| 1205207511 | N/a | Home Health | 3051 Elyria Ave, Lorain, OH 44055-1449 | 2015-10-13 |
| 1245652247 | N/a | Home Health | 2261 S Sherman Cir, Apt. A204, Miramar, FL 33025-2294 | 2014-01-09 |
| 1871868927 | N/a | Skilled Nursing Facility | 3108 Island Ct, Jeffersonville, IN 47130-8058 | 2012-03-21 |
| 1801163118 | N/a | Registered Nurse | 29078 Providence Rd, Temecula, CA 92591-5597 | 2011-11-30 |
| 1871888388 | N/a | Assisted Living Facility | 2998 W Mcmicken Ave # 1, Cincinnati, OH 45225-2362 | 2011-06-13 |
| 1861782898 | N/a | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 1318 Pennsylvania Ave, Saint Louis, MO 63133-1036 | 2011-04-11 |
| 1134676588 | N/a | Clinic/Center | 25 Fanning St, Staten Island, NY 10314-5307 | 2016-09-01 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | N/A | 3117 Apple Rd Ne, Washington, DC 20018-1605 |
| Colorado Business Entities | n/a | 4165 Plum Creek Mdws Rd., Sedalia, CO 80135 |
| Washington State Corporations | N/A CEDAR HEIGHTS-52, A WASHINGTON LIMITED PARTNERSHIP | 999 3rd Ave #1900, Seattle, WA 98104 |
| Oregon Corporations, Companies and Business Names | N/A COLONNADE-83, LIMITED PARTNERSHIP | 920 Garden St Ste A, Santa Barbara, CA 93101 |
| Colorado Business Entities | N/A Courtney Downs-89, L.P. | 920 Garden Street, Suite A, Santa Barbara, CA 93101 |
| Washington State Corporations | N/A EAGLE RANCH-67 LIMITED PARTNERSHIP | 101 Capitol Way N, Olympia, WA 98501 |
| System for Award Management (SAM) Entities | N/A INDIVIDUAL | 900 N. Lake Shore Drive Apt 402, Chicago, IL 60611-1596 |
| Colorado Business Entities | N/A Lambertson Farms-86, L.P. | 920 Garden St Ste A, Santa Barbara, CA 93101-7465 |
| Washington State Corporations | N/A MARINERS' GLEN-68, LP | 920 Garden St, Santa Barbara, CA 93101 |
| Washington State Corporations | N/A MILL PLAIN-84, L.P. | 920 Garden St, Santa Barbara, CA 93101 |
| Street Address |
4051 LONE TREE WAY STE C |
| City | ANTIOCH |
| State | CA |
| Zip Code | 94531-6204 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902406051 | Jayden Mendoza | Behavior Technician | 4849 Lone Tree Way Suite C, Antioch, CA 94531 | 2020-10-28 |
| 1093369720 | Lorena N/a Lepezmagana I | Behavior Technician | 4856 Weler Peak Way, 4856 Wexler Peak Way, Antioch, CA 94531 | 2019-07-31 |
| 1063976538 | Donna C Martinez | Respiratory Therapist, Registered | 4509 Sand Creek Rd, Antioch, CA 94531 | 2019-01-29 |
| 1215428107 | Sierra Singharath | Behavioral Analyst | 5344 Catanzaro Way, Antioch, CA 94531 | 2018-05-25 |
| 1972005551 | Meily Samantha Reyna | Behavioral Analyst | 1858 Mount Goethe Way, Antioch, CA 94531 | 2018-02-28 |
| 1225536477 | Constance Eileen Matous | Physical Therapy Assistant | 4041 Lone Tree Way Suite # 106, Antioch, CA 94531 | 2018-01-23 |
| 1851825921 | Alexander Lim Dds Inc | Dentist | 5171 Lone Tree Way, Antioch, CA 94531 | 2017-04-17 |
| 1467831222 | Jaylan Ishac | Behavioral Analyst | 4749 Crestone Peak Ct, Antioch, CA 94531 | 2015-05-27 |
| 1164831830 | Akape Home Care Agency | Home Health | 2487 Stanford Way, Ste 1a, Antioch, CA 94531 | 2014-08-07 |
| 1679992515 | Joseph Vojtko | Ophthalmology | 4501 Sand Creek Rd Dept Of, Antioch, CA 94531 | 2014-04-08 |
| Find all providers in zip 94531 | ||||
| Taxonomy Code | 251S00000X |
| Grouping | Agencies |
| Classification | Community/Behavioral Health |
| A private or public agency usually under local government jurisdiction, responsible for assuring the delivery of community based mental health, mental retardation, substance abuse and/or behavioral health services to individuals with those disabilities. Services may range from companion care, respite, transportation, community integration, crisis intervention and stabilization, supported employment, day support, prevocational services, residential support, therapeutic and supportive consultation, environmental modifications, intensive in-home therapy and day treatment, in addition to traditional mental health and behavioral treatment. |
| Notes: Source: National Medicaid EDI HIPAA NPI Sub Work Group [1/1/2007: modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649824046 | Lincoln | Community/Behavioral Health | 1708 F St, Antioch, CA 94509-2225 | 2019-07-25 |
| 1326503079 | Pcs Mental Health LLC | Community/Behavioral Health | 2031 Antioch Pike Ste 101, Antioch, TN 37013-3315 | 2019-02-07 |
| 1356810188 | Medical One, LLC | Community/Behavioral Health | 2213 Buchanan Rd Ste 202, Antioch, CA 94509-4265 | 2018-11-22 |
| 1962983262 | Lincoln | Community/Behavioral Health | 2304 G St, Antioch, CA 94509-3500 | 2018-08-24 |
| 1518448810 | Lincoln | Community/Behavioral Health | 615 Greystone Dr, Antioch, CA 94509-6990 | 2018-08-24 |
| 1609357904 | Lincoln | Community/Behavioral Health | 1931 Mokelumne Dr, Antioch, CA 94531-9129 | 2018-08-24 |
| 1053892356 | Lincoln | Community/Behavioral Health | 2801 Roosevelt Ln, Antioch, CA 94509-5038 | 2018-08-24 |
| 1700367166 | Lincoln | Community/Behavioral Health | 4721 Vista Grande Dr, Antioch, CA 94531-8619 | 2018-08-23 |
| 1407272941 | Anka Behavioral Health, Inc. | Community/Behavioral Health | 512 E St Unit B, Antioch, CA 94509 | 2014-03-07 |
| 1578848560 | La Cheim School Inc. | Community/Behavioral Health | 1413 F Street, Antioch, CA 94509-2220 | 2011-10-21 |
| Find all providers in ANTIOCH | ||||
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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.