Provider Demographics
NPI:1710577358
Name:ESSENTIAL PSYCHIATRIC SERVICES, A PROFESSIONAL NURSING CORPORATION
Entity Type:Organization
Organization Name:ESSENTIAL PSYCHIATRIC SERVICES, A PROFESSIONAL NURSING CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:L
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:AMHNP-BC
Authorized Official - Phone:951-250-5007
Mailing Address - Street 1:3160 W RAMSEY ST
Mailing Address - Street 2:
Mailing Address - City:BANNING
Mailing Address - State:CA
Mailing Address - Zip Code:92220-3724
Mailing Address - Country:US
Mailing Address - Phone:951-366-0661
Mailing Address - Fax:855-706-2054
Practice Address - Street 1:3160 W RAMSEY ST
Practice Address - Street 2:
Practice Address - City:BANNING
Practice Address - State:CA
Practice Address - Zip Code:92220-3724
Practice Address - Country:US
Practice Address - Phone:951-366-0661
Practice Address - Fax:855-706-2054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-18
Last Update Date:2023-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health