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General NPI Number Information
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NPI Number | 1104570282
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Entity Type | Organization
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Legal Business Name | INLAND EMPIRE BEHAVIORAL GROUP NURSING CORPORATION
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Dates
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Enumeration Date | 02/08/2022
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Last Update Date | 04/23/2024
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Provider Practice Location Address
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Address Line | 11801 PIERCE ST STE 200
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City | RIVERSIDE
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State | CA
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Zip | 92505-3907
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Country | US
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Telephone | 909-429-3244
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Fax | 909-981-0821
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Provider Business Mailing Address
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Address Line | 1747 STEINMAN ST
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City | RIVERSIDE
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State | CA
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Zip | 92507-7809
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Country | US
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Telephone | 909-429-3244
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | KHADIJA HAMUCHE HAMISI
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Credential | DNP
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Telephone | 909-429-3224
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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