Organization
RIVERSIDE-SAN BERNARDINO COUNTY INDIAN HEALTH, INC.
Active
Organization
RIVERSIDE-SAN BERNARDINO COUNTY INDIAN HEALTH, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK DANIEL LEBEAU (CEO)
(909) 864-1097
Entity
Organization
Contact information
Practice address
11980 MOUNT VERNON AVE, GRAND TERRACE, CA 92313-5172
(909) 864-1097
(951) 252-6879
Mailing address
11980 MOUNT VERNON AVE, GRAND TERRACE, CA 92313-5172
(909) 864-1097
(951) 225-6879
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
240000751
CA
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
250000055
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
EAP03854F
EAPC
CA
05
—
FHC03854F
—
CA
05
—
FHC03869F
—
CA
05
—
FHC70271F
—
CA
Enumeration date
10/13/2006
Last updated
07/07/2026
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