Provider Demographics
NPI:1104570282
Name:INLAND EMPIRE BEHAVIORAL GROUP NURSING CORPORATION
Entity type:Organization
Organization Name:INLAND EMPIRE BEHAVIORAL GROUP NURSING CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KHADIJA
Authorized Official - Middle Name:HAMUCHE
Authorized Official - Last Name:HAMISI
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:909-429-3224
Mailing Address - Street 1:1747 STEINMAN ST
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92507-7809
Mailing Address - Country:US
Mailing Address - Phone:909-429-3244
Mailing Address - Fax:
Practice Address - Street 1:11801 PIERCE ST STE 200
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92505-3907
Practice Address - Country:US
Practice Address - Phone:909-429-3244
Practice Address - Fax:909-981-0821
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-08
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty