Healthcare Provider Details

I. General information

NPI: 1871778803
Provider Name (Legal Business Name): BEAR VALLEY COMMUNITY HEALTH CARE DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2008
Last Update Date: 09/24/2025
Certification Date: 09/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1028 W BIG BEAR BLVD
BIG BEAR CITY CA
92314-9562
US

IV. Provider business mailing address

PO BOX 1649
BIG BEAR LAKE CA
92315-1649
US

V. Phone/Fax

Practice location:
  • Phone: 909-878-8221
  • Fax: 909-878-8284
Mailing address:
  • Phone: 909-878-8221
  • Fax: 909-878-8284

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number240000111
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number StateCA

VIII. Authorized Official

Name: MR. EVAN RAYNER
Title or Position: CEO
Credential:
Phone: 909-866-6501