Organization
COMMUNITY HOSPITAL OF SAN BERNARDINO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DARRYL VANDENBOSCH (CFO)
(909) 881-7196
Entity
Organization
Contact information
Practice address
1805 MEDICAL CENTER DR, SAN BERNARDINO, CA 92411-1217
(909) 887-6333
(909) 806-1017
Mailing address
1805 MEDICAL CENTER DR, SAN BERNARDINO, CA 92411-1217
(909) 887-6333
(909) 806-1017
Taxonomy
Speciality
Code
Description
License number
State
273R00000X
Psychiatric Hospital Unit
240000198
CA
282N00000X
General Acute Care Hospital
Primary
240000198
CA
314000000X
Skilled Nursing Facility
240000198
CA
3336I0012X
Institutional Pharmacy
HSP37939
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5615375
NCPDP
—
05
—
HSC30089F
—
CA
05
—
HSM30089F
—
CA
05
—
LTC70044F
—
CA
05
—
PHB379390
—
CA
05
—
ZZT40089F
—
CA
01
—
ZZZA3608Z
BLUE SHIELD
CA
Enumeration date
12/13/2006
Last updated
01/26/2015
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