1972711588 NPI number — COUNTY OF SAN BERNARDINO

Table of content: (NPI 1972711588)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972711588 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:
LUCERNE VALLEY COUNSELING CENTER
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:
1972711588
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/24/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
268 W HOSPITALITY LANE
Provider Second Line Business Mailing Address:
SUITE 400
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:
909-382-3080
Provider Business Mailing Address Fax Number:
909-382-3105

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
32700 OLD WOMAN SPRINGS ROAD
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
LUCERNE VALLEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92356
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-382-3080
Provider Business Practice Location Address Fax Number:
909-382-3105
Provider Enumeration Date:
05/18/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DAY
Authorized Official First Name:
MICHALE
Authorized Official Middle Name:
J
Authorized Official Title or Position:
INFORMATION TECHNOLOGY MANAGER
Authorized Official Telephone Number:
909-388-0570

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X , with the licence number:  ZZZ74743Z , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3600036BY . This is a "MEDICAL PROVIDER NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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