1265637524 NPI number — COUNTY OF SAN BERNARDINO

Table of content: (NPI 1265637524)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265637524 NPI number — COUNTY OF SAN BERNARDINO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COUNTY OF SAN BERNARDINO
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ARMC BH
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1265637524
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/18/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
303 E VANDERBILT WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN BERNARDINO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92415-0026
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-388-0801
Provider Business Mailing Address Fax Number:
909-890-0435

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
400 N. PEPPER AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLTON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92324
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-382-3127
Provider Business Practice Location Address Fax Number:
909-382-3105
Provider Enumeration Date:
06/18/2007

Additional Information

Authorized Official

Authorized Official Last Name:
PORTEOUS
Authorized Official First Name:
ERICA
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF COMPLIANCE OFFICER
Authorized Official Telephone Number:
909-388-0882

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 360008631 . This is a "MEDICAL PROVIDER NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com