1235318445 NPI number — INLAND HEALTHCARE GROUP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235318445 NPI number — INLAND HEALTHCARE GROUP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INLAND HEALTHCARE GROUP
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:
Provider Other Organization Name Type Code:
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:
1235318445
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/25/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1980 ORANGE TREE LN STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
REDLANDS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92374-4550
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-335-7171
Provider Business Mailing Address Fax Number:
909-335-7139

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7430 CHERRY AVE STE 110
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FONTANA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92336-4255
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-350-4624
Provider Business Practice Location Address Fax Number:
909-357-1160
Provider Enumeration Date:
10/24/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
PERKO
Authorized Official First Name:
LISA
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
909-335-7171

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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