Organization
COUNTY OF SAN BERNARDINO
Active
Parent organization
DEPARTMENT OF BEHAVIORAL HEALTH
Other names
Supervised Treatment After Release (STAR) Program ADS
Organization subpart
Yes
Provider details
NPI number
Legal business name
DEPARTMENT OF BEHAVIORAL HEALTH
Authorized official
ERICA OCHOA (CHIEF COMPLIANCE OFFICER)
(909) 388-0882
Entity
Organization
Contact information
Practice address
1330 E. COOLEY DR., COLTON, CA 92324-3905
(909) 580-3705
(909) 580-3747
Mailing address
303 E VANDERBILT WAY, SAN BERNARDINO, CA 92415-0026
(909) 388-0801
(909) 890-0435
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
360003697
ADP MEDI-CAL PROVIDER NUMBER
CA
Enumeration date
06/25/2007
Last updated
09/07/2022
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