RIVERSIDE-SAN BERNARDINO COUNTY INDIAN HEALTH INC. NPI 1720178478

NPI Information

NPI: 1720178478
Provider Name: RIVERSIDE-SAN BERNARDINO COUNTY INDIAN HEALTH, INC.
Classification: Clinic/Center - 261QF0400X
Entity Type: Organization

Specialization: Federally Qualified Health Center (FQHC)

Address:
11980 MOUNT VERNON AVE
GRAND TERRACE, CA
ZIP 92313
Phone: (909) 864-1097
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RIVERSIDE-SAN BERNARDINO COUNTY INDIAN HEALTH, INC. is a federally qualified health center (fqhc) clinic center in Grand Terrace, CA. RIVERSIDE-SAN BERNARDINO COUNTY INDIAN HEALTH, INC. NPI is 1720178478. The provider is registered as an organization entity type.

The provider's business location address is:

11980 MOUNT VERNON AVE
GRAND TERRACE, CA
ZIP 92313-172
Phone: (909) 864-1097
Fax: (951) 252-6879

The provider's authorized official is William Thomsen .
The authorized official title is Ceo and has the following contact phone number (951) 864-1097.

The enumeration date for this NPI number is 10/13/2006 and was last updated on 8/24/2021.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QF0400X	Clinic/Center	Federally Qualified Health Center (FQHC)	240000751	CALIFORNIA	No
2	261QF0400X	Clinic/Center	Federally Qualified Health Center (FQHC)	250000055	CALIFORNIA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	EAP03854F	OTHER	CALIFORNIA	EAPC
2	FHC70271F	MEDICAID	CALIFORNIA
3	FHC03854F	MEDICAID	CALIFORNIA
4	FHC03869F	MEDICAID	CALIFORNIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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