Healthcare Provider Details

I. General information

NPI: 1326257759
Provider Name (Legal Business Name): DEPARTMENT OF BEHAVIORAL HEALTH, SAN BERNARDINO COUNTY CA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 E FOOTHILL BLVD
RIALTO CA
92376-5230
US

IV. Provider business mailing address

268 W HOSPITALITY LN SUITE 400
SAN BERNARDINO CA
92415-0001
US

V. Phone/Fax

Practice location:
  • Phone: 909-382-3080
  • Fax: 909-382-3105
Mailing address:
  • Phone: 909-382-3080
  • Fax: 909-382-3105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberZZZ74743Z
License Number StateCA

VIII. Authorized Official

Name: MR. MICHAEL J. DAY
Title or Position: INFORMATION TECHNOLOGY MANAGER
Credential:
Phone: 909-388-0570