| Mha Antelope Valley | |
|
506 W Jackman St Lancaster CA 93534 | |
| (661) 726-2850 | |
| (661) 726-2854 |
| Full Name | Mha Antelope Valley |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 506 W Jackman St, Lancaster, California |
| Authorized Official Name and Position | Christina Miller (PRESIDENT AND CEO) |
| Authorized Official Contact | 5622851330 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mha Antelope Valley 200 Pine Ave Ste 400 Long Beach CA 90802-3039 Ph: (562) 285-1330 | Mha Antelope Valley 506 W Jackman St Lancaster CA 93534 Ph: (661) 726-2850 |
| NPI Number | 1578689402 |
|---|---|
| Provider Enumeration Date | 03/22/2007 |
| Last Update Date | 10/29/2021 |
| Certification Date | 10/29/2021 |
| Medicare PECOS PAC ID | 1759419997 |
|---|---|
| Medicare Enrollment ID | O20100510000639 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578689402 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Eugenie Boiadjieva |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1841310240 PECOS PAC ID: 8325176324 Enrollment ID: I20100512000839 |
| Provider Name | Bobby G Rose |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1942691266 PECOS PAC ID: 0941566483 Enrollment ID: I20171115003764 |
| Provider Name | Paul Pawlowski |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1235405804 PECOS PAC ID: 9830488931 Enrollment ID: I20180314002486 |
| Provider Name | Pamela Jane Poindexter |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1184284408 PECOS PAC ID: 2365808383 Enrollment ID: I20230517003098 |
| Provider Name | Evelyn Marteal Taylor |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1336532811 PECOS PAC ID: 1355707225 Enrollment ID: I20230518001902 |
| Provider Name | Roy C. Wilson |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1639180193 PECOS PAC ID: 5294731030 Enrollment ID: I20230524001201 |
| Provider Name | Joanne Marie Gryn |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1447652680 PECOS PAC ID: 3274990650 Enrollment ID: I20230530001909 |
| Provider Name | Amy Danielle Waxham |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1578878617 PECOS PAC ID: 3476910878 Enrollment ID: I20230530002749 |
| Provider Name | Francesca Smith |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811270325 PECOS PAC ID: 7214100213 Enrollment ID: I20230606002907 |
| Provider Name | Jeffrey Lynn Powell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1073965992 PECOS PAC ID: 6103206396 Enrollment ID: I20230628001567 |
| Provider Name | Josefina Arreola |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1427280841 PECOS PAC ID: 3173982840 Enrollment ID: I20230629000909 |
| Provider Name | Landon Weber |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1255859963 PECOS PAC ID: 0941669857 Enrollment ID: I20230710001743 |
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