Healthcare Provider Details

I. General information

NPI: 1033328331
Provider Name (Legal Business Name): COUNTY OF SAN BERNARDINO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 09/07/2022
Certification Date: 04/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1841 E MAIN ST
BARSTOW CA
92311-3234
US

IV. Provider business mailing address

303 E VANDERBILT WAY
SAN BERNARDINO CA
92415-0026
US

V. Phone/Fax

Practice location:
  • Phone: 760-255-5700
  • Fax: 760-256-5092
Mailing address:
  • Phone: 909-388-0801
  • Fax: 909-890-0435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License NumberZZZ74743Z
License Number StateCA

VIII. Authorized Official

Name: ERICA OCHOA
Title or Position: CHIEF COMPLIANCE OFFICER
Credential:
Phone: 909-388-0882