Provider Demographics
NPI:1316522667
Name:ASSISTANCE LEAGUE OF SAN BERNARDINO
Entity type:Organization
Organization Name:ASSISTANCE LEAGUE OF SAN BERNARDINO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTAL CHAIR
Authorized Official - Prefix:
Authorized Official - First Name:PHYLLIS
Authorized Official - Middle Name:A
Authorized Official - Last Name:HOUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-499-4520
Mailing Address - Street 1:580 W 6TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92410-3002
Mailing Address - Country:US
Mailing Address - Phone:909-885-2044
Mailing Address - Fax:
Practice Address - Street 1:580 W 6TH ST
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92410-3002
Practice Address - Country:US
Practice Address - Phone:909-885-2044
Practice Address - Fax:909-885-5900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-17
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable