Organization
COUNTY OF SAN BERNARDINO
Active
Parent organization
DEPARTMENT OF BEHAVIORAL HEALTH
Other names
Boys & Girls Club
Organization subpart
Yes
Provider details
NPI number
Legal business name
DEPARTMENT OF BEHAVIORAL HEALTH
Authorized official
MR. MICHAEL J. DAY (INFORMATION TECHNOLOGY MANAGER)
(909) 388-0570
Entity
Organization
Contact information
Practice address
1180 W 9TH ST, SAN BERNARDINO, CA 92411-2212
(909) 382-3080
(909) 382-3105
Mailing address
268 W HOSPITALITY LN, SUITE 400, SAN BERNARDINO, CA 92415-0026
(909) 382-3080
(909) 382-3105
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
ZZZ74743Z
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3600036BG
MEDICAL PROVIDER NUMBER
CA
Enumeration date
05/24/2007
Last updated
09/24/2009
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