OrganizationActive
Kaiser Permanente
NPI 1265639660 · Mental Health Clinic/Center (Including Community Mental Health Center) · Moreno Valley, CA
Provider details
- NPI number
- 1265639660
- Entity type
- Organization
- Primary specialty
- Mental Health Clinic/Center (Including Community Mental Health Center)Ambulatory Health Care Facilities
- Organization subpart
- No
- Authorized official
- Roger Melton, Counselor III(951) 601-6171
- License
- MFC17474 (CA)
Specialties & taxonomies
- Mental Health Clinic/Center (Including Community Mental Health Center)Primary261QM0801XLicense MFC17474 (CA)
Ambulatory Health Care Facilities
Profile Score
Detailed profile(89/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
18 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
12815 Heacock St
Moreno Valley, CA 92553-3116
Phone: (051) 601-6174
Fax: (951) 601-6224
Street-level locationGet directions
Mailing address
12815 Heacock St
Moreno Valley, CA 92553-3116
Registry dates
- Enumerated
- 2007-06-28
- Last updated
- 2020-08-22
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.