| |
325 W Hospitality Ln Ste 110 San Bernardino CA 92408-3210 | |
(909) 581-4854 | |
Not Available |
Full Name | |
---|---|
Speciality | Community/Behavioral Health |
Location | 325 W Hospitality Ln Ste 110, San Bernardino, California |
Authorized Official Name and Position | Monique Roach (AUTHORIZED REPRESENTATIVE) |
Authorized Official Contact | 9095814854 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
25920 Iris Ave Ste 13a #209 Moreno Valley CA 92551-1658 Ph: (909) 581-4854 | 325 W Hospitality Ln Ste 110 San Bernardino CA 92408-3210 Ph: (909) 581-4854 |
NPI Number | 1356925531 |
---|---|
Provider Enumeration Date | 05/12/2021 |
Last Update Date | 02/26/2023 |
Certification Date | 02/26/2023 |
Medicare PECOS PAC ID | 2163879370 |
---|---|
Medicare Enrollment ID | O20231109002206 |
Identifier | Type | State | Issuer |
---|---|---|---|
1356925531 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
Provider Name | Monique N Roach |
---|---|
Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1144781733 PECOS PAC ID: 3971837972 Enrollment ID: I20190625003046 |
Cynthia J Soto Md Inc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 399 E Highland Ave Ste 223, San Bernardino, CA 92404 Phone: 909-475-5200 | |
Youth Hope Licensed Clinical Social Worker Corp Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 255 N D St Ste 400, San Bernardino, CA 92401 Phone: 909-567-2808 | |
Beyond Wellness Pllc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 2150 N Waterman Ave Ste 101, San Bernardino, CA 92404 Phone: 833-759-8720 | |