Provider Demographics
NPI:1619305760
Name:MENTAL HEALTH SERVICES
Entity Type:Organization
Organization Name:MENTAL HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DRUG AND ALCOHOL COUNSELOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:HOBSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-918-7241
Mailing Address - Street 1:5394 SIERRA RD
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92407-3241
Mailing Address - Country:US
Mailing Address - Phone:909-918-7241
Mailing Address - Fax:
Practice Address - Street 1:5394 SIERRA RD
Practice Address - Street 2:1874 BUSINESS CENTER DR SAN BERNARDINO CA 92408
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92407-3241
Practice Address - Country:US
Practice Address - Phone:909-918-7241
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-29
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes276400000XHospital UnitsRehabilitation, Substance Use Disorder Unit