Provider Demographics
NPI:1699108894
Name:RIVERSIDE-SAN BERNARDINO COUNTY INDIAN HEALTH, INC
Entity type:Organization
Organization Name:RIVERSIDE-SAN BERNARDINO COUNTY INDIAN HEALTH, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BILL
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MHA
Authorized Official - Phone:909-864-1097
Mailing Address - Street 1:170 YUCCA AVE
Mailing Address - Street 2:
Mailing Address - City:BARSTOW
Mailing Address - State:CA
Mailing Address - Zip Code:92311-3231
Mailing Address - Country:US
Mailing Address - Phone:760-256-9016
Mailing Address - Fax:
Practice Address - Street 1:170 YUCCA AVE
Practice Address - Street 2:
Practice Address - City:BARSTOW
Practice Address - State:CA
Practice Address - Zip Code:92311-3231
Practice Address - Country:US
Practice Address - Phone:760-256-9016
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-12
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care