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NPI Code Detail

MEDICARE: SAC HEALTH SYSTEM

MEDICARE: SAC HEALTH SYSTEM
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QC1500XCommunity Health Clinic/Center
2261QF0400XFederally Qualified Health Center (FQHC)

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2ENVOY3000OTHERCAENVOY SITE ID
3EAP70708FOTHERCAEAPC

General Provider Information

NPI Number : 1386266112
Entity Type Code : Organization
Provider Name (Legal Business Name) : SAC HEALTH SYSTEM
Provider Business Mailing Address
First Line : 815 S WILLOW AVE
Second Line :
City : RIALTO
State : CA
Zip : 92376-6934
Country : US
Telephone Number : 909-382-7100
Fax Number : 909-382-7101
Provider Business Practice Location Address
First Line : 815 S WILLOW AVE
Second Line :
City : RIALTO
State : CA
Zip : 92376-6934
Country : US
Telephone Number : 909-382-7100
Fax Number : 909-382-7101
Authorized Official
Title or Position : DIRECTOR OF BILLING
Name : TASHA AMICK
Credential :
Telephone Number : 909-382-7100
Provider Enumeration Date : 05/14/2020
Last Update Date : 04/21/2025

Similar Medicare Providers

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Practice Location Address:
815 S WILLOW AVE
RIALTO, CA
92376-6934
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Practice Fax:
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1336331529 — MRS. MARY RUTH STEWART C.P.N.P.
Practice Location Address:
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RIALTO, CA
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Practice Phone: 909-820-4431
Practice Fax: 909-820-7770
1265286611 — MRS. CECILIA GATCHALIAN GUTIERREZ MSN, RN
Practice Location Address:
815 S WILLOW AVE
RIALTO, CA
92376-6934
Practice Phone: 909-820-8150
Practice Fax: 909-820-8151
1528816097 — MR. EJERE OKORIE RN
Practice Location Address:
815 S WILLOW AVE
RIALTO, CA
92376-6934
Practice Phone: 909-820-8150
Practice Fax:
1922857846 — CYNTHIA NWADIKE MSN, RN
Practice Location Address:
815 S WILLOW AVE
RIALTO, CA
92376-6934
Practice Phone: 909-820-8150
Practice Fax: 909-820-8151

Directions to “SAC HEALTH SYSTEM ” Practice Location

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