Provider Demographics
NPI:1194976563
Name:CHW SO. CALIFORNIA
Entity type:Organization
Organization Name:CHW SO. CALIFORNIA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHAIR FOR THE DEPARTMENT OF NURSING
Authorized Official - Prefix:MRS
Authorized Official - First Name:FAYE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOWER
Authorized Official - Suffix:
Authorized Official - Credentials:DNSC, FAA
Authorized Official - Phone:510-436-1000
Mailing Address - Street 1:681 N BRIERWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:RIALTO
Mailing Address - State:CA
Mailing Address - Zip Code:92376-4776
Mailing Address - Country:US
Mailing Address - Phone:909-879-7803
Mailing Address - Fax:
Practice Address - Street 1:681 N BRIERWOOD AVE
Practice Address - Street 2:
Practice Address - City:RIALTO
Practice Address - State:CA
Practice Address - Zip Code:92376-4776
Practice Address - Country:US
Practice Address - Phone:909-879-7803
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-03
Last Update Date:2008-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service