Healthcare Provider Details

I. General information

NPI: 1508075805
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: 04/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 BAILEY AVE STE 2
NEEDLES CA
92363-3105
US

IV. Provider business mailing address

303 E VANDERBILT WAY
SAN BERNARDINO CA
92415-0026
US

V. Phone/Fax

Practice location:
  • Phone: 760-326-9313
  • Fax:
Mailing address:
  • Phone: 909-388-0801
  • Fax: 909-890-0435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

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