Organization
INLAND COUNTIES REGIONAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARY LYNN CLARK (DIRECTOR)
(909) 890-3400
Entity
Organization
Contact information
Practice address
674 E BRIER DR, SAN BERNARDINO, CA 92408-2800
(909) 890-3000
(909) 890-3001
Mailing address
PO BOX 6127, SAN BERNARDINO, CA 92412-6127
(909) 890-3000
(909) 890-3001
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GPT001490
—
CA
05
—
GRR000010
—
CA
05
—
GRRCT00010
—
CA
05
—
GRRP00010
—
CA
Enumeration date
06/07/2007
Last updated
08/22/2020
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