Organization
SAN BERNARDINO COUNTY/CCS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KEN ADAMS MPH (PROGRAM MANAGER)
(909) 387-8400
Entity
Organization
Contact information
Practice address
1451 E. PENNSYLVANIA AVE., REDLANDS MTU, REDLANDS, CA 92374
(909) 307-2441
Mailing address
351 N MOUNTAIN VIEW AVE, SAN BERNARDINO, CA 92415-1018
(909) 387-6218
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
—
—
2251P0200X
Pediatric Physical Therapist
—
—
225200000X
Physical Therapy Assistant
—
—
225XP0200X
Pediatric Occupational Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CCS00133F
MEDICAL
CA
Enumeration date
10/17/2007
Last updated
10/27/2007
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