Organization
RIVERSIDE-SAN BERNARDINO COUNTY INDIAN HEALTH, INC.
Active
Other names
Sasn Manuel Indian Health Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BILL THOMSEN (CHIEF OPERATIONS OFFICER)
(909) 864-1097
Entity
Organization
Contact information
Practice address
11980 MOUNT VERNON AVE, GRAND TERRACE, CA 92313-5172
(909) 864-1097
Mailing address
11980 MOUNT VERNON AVE, GRAND TERRACE, CA 92313-5172
(909) 864-1097
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
240000751
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1174676670
NPI
CA
Enumeration date
11/23/2015
Last updated
11/23/2015
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