Healthcare Provider Details

I. General information

NPI: 1700748175
Provider Name (Legal Business Name): SAC HEALTH SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2025
Last Update Date: 11/25/2025
Certification Date: 11/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 PACIFIC ST STE B
SAN BERNARDINO CA
92404-6228
US

IV. Provider business mailing address

1003 E BRIER DR
SAN BERNARDINO CA
92408-2817
US

V. Phone/Fax

Practice location:
  • Phone: 909-382-7100
  • Fax: 909-382-7101
Mailing address:
  • Phone: 909-382-7100
  • Fax: 909-382-7101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: TASHA AMICK
Title or Position: DIRECTOR OF BILLING
Credential:
Phone: 909-382-7100