Provider Demographics
NPI:1194811000
Name:MORONGO BASIN MENTAL HEALTH SERVICES ASSOC INC
Entity type:Organization
Organization Name:MORONGO BASIN MENTAL HEALTH SERVICES ASSOC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSHBROOK
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:760-365-3022
Mailing Address - Street 1:55475 SANTA FE TRL
Mailing Address - Street 2:
Mailing Address - City:YUCCA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92284-3117
Mailing Address - Country:US
Mailing Address - Phone:760-365-3022
Mailing Address - Fax:760-365-3513
Practice Address - Street 1:55475 SANTA FE TRL
Practice Address - Street 2:
Practice Address - City:YUCCA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92284-3117
Practice Address - Country:US
Practice Address - Phone:760-365-3022
Practice Address - Fax:760-365-3513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ78331ZMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER