1073553756 NPI number — BEAR VALLEY COMMUNITY HEALTH CARE DISTRICT

Table of content: (NPI 1073553756)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073553756 NPI number — BEAR VALLEY COMMUNITY HEALTH CARE DISTRICT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BEAR VALLEY COMMUNITY HEALTH CARE DISTRICT
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:
BEAR VALLEY COMMUNITY HOSPITAL
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:
1073553756
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/23/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1649
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BIG BEAR LAKE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92315
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-878-8276
Provider Business Mailing Address Fax Number:
909-878-8282

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
41870 GARSTIN DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BIG BEAR LAKE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92315
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-878-8276
Provider Business Practice Location Address Fax Number:
909-878-8282
Provider Enumeration Date:
06/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HAMBLIN
Authorized Official First Name:
GARTH
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
909-878-8276

Provider Taxonomy Codes

  • Taxonomy code: 261QR1300X , with the licence number:  240000111 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282E00000X , with the licence number: 240000111 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282NC0060X , with the licence number: 240000111 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336L0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: RHM08614F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: HSP40618J , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: LTC555468F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: ZZZ24958Z . This is a "MEDICARE PROFESSIONAL" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 1073553756 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: HSP30618J , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: RHM18564F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com