1326259284 NPI number — SAN BERNARDINO MOUNTAINS COMMUNITY HOSPITAL

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 1326259284 NPI number — SAN BERNARDINO MOUNTAINS COMMUNITY HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SAN BERNARDINO MOUNTAINS COMMUNITY HOSPITAL
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:
1326259284
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
29101 HOSPITAL RD
Provider Second Line Business Mailing Address:
PO BOX 70
Provider Business Mailing Address City Name:
LAKE ARROWHEAD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92352
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-336-3651
Provider Business Mailing Address Fax Number:
909-336-4631

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
29101 HOSPITAL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKE ARROWHEAD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92352
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-336-3651
Provider Business Practice Location Address Fax Number:
909-336-4631
Provider Enumeration Date:
05/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CRAWFORD
Authorized Official First Name:
DANIEL
Authorized Official Middle Name:
G
Authorized Official Title or Position:
PHARMACY MANAGER
Authorized Official Telephone Number:
909-436-3003

Provider Taxonomy Codes

  • Taxonomy code: 282E00000X , with the licence number:  HSP 36642 , 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)





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