MARY'S SHELTER (NPI# 1053934158) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1053934158 |
| Entity Type | Organization |
| Organization Name | MARY'S SHELTER |
| Other Organization Name | MARY'S PATH - HOUSE 1 |
| Practice Address |
18221 E 17th St Santa Ana CA 92705-2676 |
| Practice Telephone | 7147300930 |
| Mailing Telephone | 7147300930 |
| Enumeration Date | 2020-05-22 |
| Last Update Date | 2020-10-26 |
| Authorized Official Name | KELLI CAYLEY STRICKLAND (LEAD SOCIAL WORKER) |
| Authorized Official Telephone | 7147300930 |
| Authorized Official Credential | LCSW |
| Is Organization Subpart | Y |
| Parent Organization Name | MARY'S SHELTER |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 322D00000X | Residential Treatment Facility, Emotionally Disturbed Children | Residential Treatment Facilities |
| Other Name | Type Code |
|---|---|
| Mary's Path - House 1 | Doing Business As Name - Organization |
| Mary's Path - House 1 | Other Name - Individual/Organization |
| Mary's Path-House 1 | Other Name - Individual/Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689212698 | Mary's Shelter | Meals | 615 Kenhorst Blvd, Reading, PA 19611-1717 | 2019-12-20 |
| 1508356502 | Mary's Shelter | Residential Treatment Facility, Emotionally Disturbed Children | 18241 E 17th St, Santa Ana, CA 92705-2676 | 2018-05-15 |
| 1821529199 | Mary's Shelter | Residential Treatment Facility, Emotionally Disturbed Children | 18221 E 17th St, Santa Ana, CA 92705-2676 | 2017-03-27 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | MARY'S SHELTER | 615 Kenhorst Blvd, Reading, PA 19611-1717 |
| Street Address |
18221 E 17TH ST |
| City | SANTA ANA |
| State | CA |
| Zip Code | 92705-2676 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871033399 | Elizabeth Mojica | Social Worker | 18221 E 17th St, Santa Ana, CA 92705-2676 | 2017-03-02 |
| 1821529199 | Mary's Shelter | Residential Treatment Facility, Emotionally Disturbed Children | 18221 E 17th St, Santa Ana, CA 92705-2676 | 2017-03-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952919763 | John G. Alevizos, D.o., A Professional Medical Corporation | Preventive Medicine | 1530 East Edinger Avenue, Suite 1, Santa Ana, CA 92705 | 2020-07-17 |
| 1477186625 | Joyce Altman Interpreters, Inc. | Interpreter | 1971 East 4th Street, Ste 206, Santa Ana, CA 92705 | 2020-02-17 |
| 1588214688 | Cindy Mejia | Behavior Technician | 505 N. Tustin Ave., #152, Santa Ana, CA 92705 | 2019-09-19 |
| 1588210504 | Jennifer Ang Lim-quevedo | Nurse Practitioner | 18362 Whitney Dr, Santa Ana, CA 92705 | 2019-08-15 |
| 1962056820 | Melinda Acosta Black | Social Worker | 1526 Brookhollow Drive, Santa Ana, CA 92705 | 2019-07-30 |
| 1972069631 | Amy Marie Elit | Nurse Practitioner | 1751 E Harry Ave, Santa Ana, CA 92705 | 2019-02-18 |
| 1386118180 | Unified Behavioral Health, LLC | Substance Abuse Rehabilitation Facility | 1218 W Santa Ana Blvd, Santa Ana, CA 92705 | 2019-01-15 |
| 1952884736 | Javier Perales | Social Worker | 1652 Windsor Ln, Santa Ana, CA 92705 | 2018-09-08 |
| 1073009700 | Eva E Kuncewicki | Marriage & Family Therapist | 1001 S Grand Ave # B, Santa Ana, CA 92705 | 2018-07-05 |
| 1487149886 | Nimbus Medtransport Inc. | Non-emergency Medical Transport (VAN) | 2112 E 4th St Ste 235, Santa Ana, CA 92705 | 2018-06-27 |
| Find all providers in zip 92705 | ||||
| Taxonomy Code | 322D00000X |
| Grouping | Residential Treatment Facilities |
| Classification | Residential Treatment Facility, Emotionally Disturbed Children |
| A provider facility or distinct part of the organization which renders an interdisciplinary program of mental health treatment to individuals under 21 years of age who have persistent dysfunction in major life areas. The dysfunction is of an extent and pervasiveness that requires a protected and highly structured therapeutic environment. These organizations, or distinct part of organizations, exclude those that provide acute psychiatric care, partial hospitalization, group living, therapeutic schooling, primary diagnosis substance abuse disorder treatment, or primary diagnosis mental retardation or developmental disability treatment. |
| Notes: Source: U.S. Department of Defense Regulation 6010.8-R, Chapter 6. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508356502 | Mary's Shelter | Residential Treatment Facility, Emotionally Disturbed Children | 18241 E 17th St, Santa Ana, CA 92705-2676 | 2018-05-15 |
| 1659878809 | Olive Crest | Residential Treatment Facility, Emotionally Disturbed Children | 13442 Malena Dr, Santa Ana, CA 92705-1912 | 2018-04-12 |
| 1366949513 | Olive Crest | Residential Treatment Facility, Emotionally Disturbed Children | 19356 Saylor Terrace, Santa Ana, CA 92705 | 2018-04-12 |
| 1821529199 | Mary's Shelter | Residential Treatment Facility, Emotionally Disturbed Children | 18221 E 17th St, Santa Ana, CA 92705-2676 | 2017-03-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144820499 | Catholic Charities of The Diocese of Oakland | Residential Treatment Facility, Emotionally Disturbed Children | 3700 Dorisa Ave, Oakland, CA 94605-4941 | 2020-10-27 |
| 1922607944 | Inspire A Youth, Inc | Residential Treatment Facility, Emotionally Disturbed Children | 7556 Avenida Baja, Riverside, CA 92509-3449 | 2020-10-21 |
| 1235736554 | Yvonne Dionne Robinson | Residential Treatment Facility, Emotionally Disturbed Children | 1223 E Helmick St, Carson, CA 90746-3163 | 2020-10-09 |
| 1740897784 | Paradise Adolescent Home, Inc. | Residential Treatment Facility, Emotionally Disturbed Children | 602 Woodlark Dr, Suisun City, CA 94585-2244 | 2020-09-24 |
| 1548877657 | T & T House of Champions | Residential Treatment Facility, Emotionally Disturbed Children | 2115 High St, Oakland, CA 94601-4335 | 2020-09-23 |
| 1902412182 | Paradise Adolescent Home, Inc. | Residential Treatment Facility, Emotionally Disturbed Children | 136 Valdivia Cir, San Ramon, CA 94583-2228 | 2020-09-22 |
| 1073128492 | Samuel Campbell Jr. | Residential Treatment Facility, Emotionally Disturbed Children | 4200 Crescent Rock Ln, Bakersfield, CA 93311-2860 | 2020-09-11 |
| 1336753433 | Aaron's Boys Home | Residential Treatment Facility, Emotionally Disturbed Children | 5805 Capistrano Ave Ste E, Atascadero, CA 93422-7218 | 2020-09-04 |
| 1699389452 | Millie's Youth Services, Inc | Residential Treatment Facility, Emotionally Disturbed Children | 2512 Havenscourt Blvd, Oakland, CA 94605-1935 | 2020-08-31 |
| 1538779871 | Hidden Treasures Foundation, Inc | Residential Treatment Facility, Emotionally Disturbed Children | 1240 W 13th Ave, Escondido, CA 92025-5560 | 2020-08-02 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.