Healthcare Provider Details

I. General information

NPI: 1508399312
Provider Name (Legal Business Name): SAN BERNARDINO HOME HEALTH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2017
Last Update Date: 10/27/2022
Certification Date: 10/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N MOUNTAIN AVE #C202
UPLAND CA
91786-4367
US

IV. Provider business mailing address

600 N MOUNTAIN AVE #C202
UPLAND CA
91786-4367
US

V. Phone/Fax

Practice location:
  • Phone: 909-966-4852
  • Fax: 310-878-0326
Mailing address:
  • Phone: 909-966-4852
  • Fax: 310-878-0326

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. ROBERT B YOUNG
Title or Position: CEO/PRESIDENT
Credential:
Phone: 818-739-4880