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General NPI Number Information
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NPI Number | 1134322159
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Entity Type | Organization
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Legal Business Name | INLAND COUNTIES REGIONAL CENTER
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Dates
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Enumeration Date | 06/07/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 674 E BRIER DR
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City | SAN BERNARDINO
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State | CA
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Zip | 92408-2800
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Country | US
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Telephone | 909-890-3000
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Fax | 909-890-3001
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Provider Business Mailing Address
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Address Line | PO BOX 6127
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City | SAN BERNARDINO
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State | CA
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Zip | 92412-6127
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Country | US
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Telephone | 909-890-3000
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Fax | 909-890-3001
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Authorized Official
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Title or Position | DIRECTOR
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Name | MARY LYNN CLARK
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Credential |
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Telephone | 909-890-3400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State | CA
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