Provider Demographics
NPI: | 1134693153 |
---|---|
Name: | CITADEL COMMUNITY CARE FACILITIES |
Entity Type: | Organization |
Organization Name: | CITADEL COMMUNITY CARE FACILITIES |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | EXECUTIVE DIRECTOR |
Authorized Official - Prefix: | |
Authorized Official - First Name: | ANNETTE |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | PUNIMATA |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 909-992-0929 |
Mailing Address - Street 1: | 568 N MOUNTAIN VIEW AVE |
Mailing Address - Street 2: | |
Mailing Address - City: | SAN BERNARDINO |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 92401-1231 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 909-992-0929 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 568 N MOUNTAIN VIEW AVE |
Practice Address - Street 2: | |
Practice Address - City: | SAN BERNARDINO |
Practice Address - State: | CA |
Practice Address - Zip Code: | 92401-1231 |
Practice Address - Country: | US |
Practice Address - Phone: | 909-992-0929 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2019-01-12 |
Last Update Date: | 2022-04-21 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 251S00000X | Agencies | Community/Behavioral Health | |
No | 253J00000X | Agencies | Foster Care Agency | |
No | 261QM0801X | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |
No | 261QM0850X | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health |
No | 261QM0855X | Ambulatory Health Care Facilities | Clinic/Center | Adolescent and Children Mental Health |
No | 261QR0405X | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Substance Use Disorder |
No | 322D00000X | Residential Treatment Facilities | Residential Treatment Facility, Emotionally Disturbed Children | |
No | 324500000X | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility | |
No | 3245S0500X | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility | Substance Abuse Treatment, Children |