Organization
SAC HEALTH SYSTEM
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TASHA AMICK (DIRECTOR OF BILLING)
(909) 382-7100
Entity
Organization
Contact information
Practice address
82934 CIVIC CENTER DR, INDIO, CA 92201-4308
(909) 382-7100
Mailing address
250 S G ST, SAN BERNARDINO, CA 92410-3320
(909) 382-7100
(909) 382-7101
Taxonomy
Speciality
Code
Description
License number
State
261QC1500X
Community Health Clinic/Center
CMM70708F
CA
261QD0000X
Dental Clinic/Center
G91341
CA
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
CMM70708F
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
CMM70708F
—
CA
01
—
EAP70708F
EAPC
CA
01
—
ENVOY3000
ENVOY SITE ID
CA
Enumeration date
04/20/2017
Last updated
04/21/2025
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