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General NPI Number Information
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NPI Number | 1982728689
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Entity Type | Organization
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Legal Business Name | FOUNDATION FOR CALIFORNIA STATE UNIVERSITY, SAN BERNARDINO
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Dates
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Enumeration Date | 03/19/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 164 W HOSPITALITY LN SUITE 1A
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City | SAN BERNARDINO
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State | CA
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Zip | 92408-3316
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Country | US
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Telephone | 909-379-1525
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Fax |
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Provider Business Mailing Address
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Address Line | 5500 UNIVERSITY PARKWAY
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City | SAN BERNARDINO
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State | CA
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Zip | 92407
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | INTERIM GENERAL MANAGER
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Name | MS. DEBORAH BURNS
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Credential |
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Telephone | 909-537-3939
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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