Healthcare Provider Details

I. General information

NPI: 1952308009
Provider Name (Legal Business Name): COMMUNITY HEALTH SYSTEMS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18601 VALLEY BLVD
BLOOMINGTON CA
92316-1831
US

IV. Provider business mailing address

18601 VALLEY BLVD
BLOOMINGTON CA
92316-1831
US

V. Phone/Fax

Practice location:
  • Phone: 909-877-1818
  • Fax: 909-746-0400
Mailing address:
  • Phone: 909-877-1818
  • Fax: 909-746-0400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number240000086
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number250000756
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number250000807
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number080000150
License Number StateCA

VIII. Authorized Official

Name: MR. BOBBY VASCOVICH
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 909-877-1818