Provider Demographics
NPI:1386266112
Name:SAC HEALTH SYSTEM
Entity type:Organization
Organization Name:SAC HEALTH SYSTEM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF BILLING
Authorized Official - Prefix:
Authorized Official - First Name:TASHA
Authorized Official - Middle Name:
Authorized Official - Last Name:AMICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-382-7100
Mailing Address - Street 1:815 S WILLOW AVE
Mailing Address - Street 2:
Mailing Address - City:RIALTO
Mailing Address - State:CA
Mailing Address - Zip Code:92376-6934
Mailing Address - Country:US
Mailing Address - Phone:909-382-7100
Mailing Address - Fax:909-382-7101
Practice Address - Street 1:815 S WILLOW AVE
Practice Address - Street 2:
Practice Address - City:RIALTO
Practice Address - State:CA
Practice Address - Zip Code:92376-6934
Practice Address - Country:US
Practice Address - Phone:909-382-7100
Practice Address - Fax:909-382-7101
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAC HEALTH SYSTEM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-05-14
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACMM70708FMedicaid
CAENVOY3000OtherENVOY SITE ID
CAEAP70708FOtherEAPC