Organization
INLAND EMPIRE BEHAVIORAL GROUP NURSING CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KHADIJA HAMUCHE HAMISI DNP (CEO)
(909) 429-3224
Entity
Organization
Contact information
Practice address
11801 PIERCE ST STE 200, RIVERSIDE, CA 92505-3907
(909) 429-3244
(909) 981-0821
Mailing address
1747 STEINMAN ST, RIVERSIDE, CA 92507-7809
(909) 429-3244
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
—
—
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
Other
Enumeration date
02/08/2022
Last updated
04/23/2024
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