PROMESA BEHAVIORAL HEALTH-BARSTOW (NPI# 1245725506) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1245725506 |
| Entity Type | Organization |
| Organization Name | PROMESA BEHAVIORAL HEALTH-BARSTOW |
| Practice Address |
1415 W Barstow Ave Fresno CA 93711 |
| Mailing Address |
7120 N Marks Ave Ste 110 Fresno CA 93711-0268 |
| Practice Telephone | 5594395437 |
| Mailing Telephone | 5593412394 |
| Enumeration Date | 2018-06-28 |
| Last Update Date | 2018-08-13 |
| Authorized Official Name | AMANDA IRENE REED (DIRECTOR) |
| Authorized Official Telephone | 5594395437 |
| Authorized Official Credential | LMFT |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 320800000X | Community Based Residential Treatment Facility, Mental Illness | 107200789 | CA | Residential Treatment Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | 101044 | 05 |
| Street Address |
1415 W BARSTOW AVE |
| City | FRESNO |
| State | CA |
| Zip Code | 93711 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962044339 | Janine Mora | Counselor | 1415 W Barstow Ave, Fresno, CA 93711-3018 | 2019-10-17 |
| 1740845353 | Christian Emilio Olivas | Counselor | 1415 W Barstow Ave, Fresno, CA 93711-3018 | 2019-05-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104464684 | Kazi Shafiul Moula | Dentist | Western Dental/ Brident 150bfo, 3077 W Shaw Ave, Fresno, CA 93711 | 2019-12-16 |
| 1760037063 | Armine Petrosyan | Nurse Practitioner | 427 W Beford Ave Suite 103, Fresno, CA 93711 | 2019-08-05 |
| 1912489360 | Shoua Nelson | Nurse Practitioner | 2490 W. Shaw Avenue Suite 101, Fresno, CA 93711 | 2018-09-02 |
| 1407344138 | Aidan Mechem | Behavior Technician | 5140 N. Fruit Avene, Fresno, CA 93711 | 2018-04-27 |
| 1841798840 | Michael Ramos IIi | Behavior Technician | 1690 N Shaw Ave, 102, Fresno, CA 93711 | 2018-01-25 |
| 1962913467 | Dhara Devendrakumar Patel | Pharmacist | 740 West Alluvial Avenue, Suite 101, Fresno, CA 93711 | 2017-10-24 |
| 1588183636 | Bianca Arteaga | Counselor | 7485 N. Palm Ave., Suite 103, Fresno, CA 93711 | 2017-09-10 |
| 1346763158 | Powell Pediatric Dentistry Ingram Partnership | Dentist | 7761 N Ingram Ave, Suite 101, Fresno, CA 93711 | 2017-07-24 |
| 1982124202 | Justine Syera Balbas | Counselor | 2766 W. Celeste Ave., Unit 103, Fresno, CA 93711 | 2017-06-27 |
| 1356870604 | Alma B Vega | Counselor | 2684 W Stuart Ave, Fresno, CA 93711 | 2017-06-09 |
| Find all providers in zip 93711 | ||||
| Taxonomy Code | 320800000X |
| Grouping | Residential Treatment Facilities |
| Classification | Community Based Residential Treatment Facility, Mental Illness |
| A home-like residential facility providing psychiatric treatment and psycho/social rehabilitative services to individuals diagnosed with mental illness. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326645904 | New Passages Group Home, Inc. | Community Based Residential Treatment Facility, Mental Illness | 5675 E Ashlan Ave, Fresno, CA 93727-7220 | 2020-10-06 |
| 1467060053 | Michigan House Inc. | Community Based Residential Treatment Facility, Mental Illness | 1224 E Michigan Ave, Fresno, CA 93704-5731 | 2020-07-20 |
| 1346877594 | 2nd Home Incorporated | Community Based Residential Treatment Facility, Mental Illness | 3239 E Tenaya Way, Fresno, CA 93710-5924 | 2020-03-26 |
| 1174185722 | Dn Associates | Community Based Residential Treatment Facility, Mental Illness | 3793 N Polk Ave, Fresno, CA 93722-9763 | 2019-07-03 |
| 1770143646 | Core Conditions, Inc. | Community Based Residential Treatment Facility, Mental Illness | 3765 W Dakota Ave, Fresno, CA 93722-4784 | 2019-06-13 |
| 1891354023 | Core Conditions, Inc. | Community Based Residential Treatment Facility, Mental Illness | 114 S Brawley Ave, Fresno, CA 93706-2103 | 2019-06-11 |
| 1093892663 | Crestwood Behavioral Health, Inc. | Community Based Residential Treatment Facility, Mental Illness | 153 N U St, Fresno, CA 93701-2438 | 2006-11-01 |
| 1972112563 | Michigan House Inc. | Community Based Residential Treatment Facility, Mental Illness | 1209 S Hughes Ave, Fresno, CA 93706-2321 | 2020-07-29 |
| 1063021921 | Hope for Youth, Inc. | Community Based Residential Treatment Facility, Mental Illness | 4324 W Harvard Ave, Fresno, CA 93722-5183 | 2020-07-27 |
| 1033727326 | Manuch Inc. | Community Based Residential Treatment Facility, Mental Illness | 5610 W Donner Ave, Fresno, CA 93722-3721 | 2020-07-22 |
| Find all providers in FRESNO | ||||
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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.