Healthcare Provider Details

I. General information

NPI: 1063280642
Provider Name (Legal Business Name): SAC HEALTH SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2023
Last Update Date: 04/21/2025
Certification Date: 04/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 E MOUNTAIN VIEW ST # 102
BARSTOW CA
92311-3053
US

IV. Provider business mailing address

250 S G ST
SAN BERNARDINO CA
92410-3320
US

V. Phone/Fax

Practice location:
  • Phone: 909-382-7100
  • Fax: 909-382-7101
Mailing address:
  • Phone: 909-382-7100
  • Fax: 909-382-7101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: TASHA AMICK
Title or Position: DIRECTOR OF BILLING
Credential:
Phone: 909-219-8665