MEDICARE: COMMUNITY HOSPITAL OF SAN BERNARDINO

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
1	3140N1450X	Pediatric Skilled Nursing Facility	240000185	CA

Other Identifiers

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

General Provider Information

NPI Number	:	1851395685
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY HOSPITAL OF SAN BERNARDINO

Provider Business Mailing Address
First Line	:	1676 MEDICAL CENTER DR
Second Line	:
City	:	SAN BERNARDINO
State	:	CA
Zip	:	92411-1213
Country	:	US
Telephone Number	:	909-887-6481
Fax Number	:	909-887-3858

Provider Business Practice Location Address
First Line	:	1676 MEDICAL CENTER DR
Second Line	:
City	:	SAN BERNARDINO
State	:	CA
Zip	:	92411-1213
Country	:	US
Telephone Number	:	909-887-6481
Fax Number	:	909-887-3858

Authorized Official
Title or Position	:	V.P. FIANANCE, CFO
Name	:	MR. ED SORENSON
Credential	:
Telephone Number	:	909-887-6333

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	09/23/2013

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Directions to “COMMUNITY HOSPITAL OF SAN BERNARDINO ” Practice Location

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