Healthcare Provider Details

I. General information

NPI: 1427464429
Provider Name (Legal Business Name): INLAND VALLEY RECOVERY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2014
Last Update Date: 12/28/2023
Certification Date: 12/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

955 N D ST
SAN BERNARDINO CA
92410-3519
US

IV. Provider business mailing address

916 N MOUNTAIN AVE SUITE A
UPLAND CA
91786-3697
US

V. Phone/Fax

Practice location:
  • Phone: 909-889-6519
  • Fax: 909-889-6560
Mailing address:
  • Phone: 909-932-1069
  • Fax: 909-932-1087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number360001ABN
License Number StateCA

VIII. Authorized Official

Name: TINA HUGHES
Title or Position: CEO
Credential:
Phone: 909-932-1069