Healthcare Provider Details

I. General information

NPI: 1851395685
Provider Name (Legal Business Name): COMMUNITY HOSPITAL OF SAN BERNARDINO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 09/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1676 MEDICAL CENTER DR
SAN BERNARDINO CA
92411-1213
US

IV. Provider business mailing address

1676 MEDICAL CENTER DR
SAN BERNARDINO CA
92411-1213
US

V. Phone/Fax

Practice location:
  • Phone: 909-887-6481
  • Fax: 909-887-3858
Mailing address:
  • Phone: 909-887-6481
  • Fax: 909-887-3858

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3140N1450X
TaxonomyPediatric Skilled Nursing Facility
License Number240000185
License Number StateCA

VIII. Authorized Official

Name: MR. ED SORENSON
Title or Position: V.P. FIANANCE, CFO
Credential:
Phone: 909-887-6333