RIVERSIDE-SAN BERNARDINO COUNTY INDIAN HEALTH, INC. (NPI# 1174676670) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1174676670 |
| Entity Type | Organization |
| Organization Name | RIVERSIDE-SAN BERNARDINO COUNTY INDIAN HEALTH, INC. |
| Other Organization Name | SAN MANUEL INDIAN HEALTH |
| Practice Address |
11980 Mount Vernon Ave Grand Terrace CA 92313-5172 |
| Practice Telephone | 9098641097 |
| Practice Fax Number | 9097443960 |
| Mailing Telephone | 9098641097 |
| Mailing Fax Number | 9097443960 |
| Enumeration Date | 2007-01-19 |
| Last Update Date | 2016-10-26 |
| Authorized Official Name | MR. MARK J JENSEN (CHIEF FINANCIAL OFFICIER) |
| Authorized Official Telephone | 9098641097 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QF0400X |
Clinic/Center Specialization: Federally Qualified Health Center (FQHC) |
240000751 | CA | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | FHC03869F | 05 |
| Other Name | Type Code |
|---|---|
| San Manuel Indian Health | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043363641 | Riverside-san Bernardino County Indian Health, Inc. | Clinic/Center | 66735 Martinez Rd, Thermal, CA 92274-9007 | 2007-01-19 |
| 1659424885 | Riverside-san Bernardino County Indian Health, Inc. | Clinic/Center | 39100 Contreras Rd, Suite C, Anza, CA 92539-8724 | 2007-01-19 |
| 1891169249 | Riverside-san Bernardino County Indian Health, Inc. | Clinic/Center | 11980 Mount Vernon Ave, Grand Terrace, CA 92313-5172 | 2015-11-23 |
| 1841417300 | Riverside-san Bernardino County Indian Health, Inc. | Clinic/Center | 11555 Potrero Rd, Banning, CA 92220-6946 | 2007-04-19 |
| 1639222144 | Riverside-san Bernardino County Indian Health, Inc. | Clinic/Center | 607 Donna Way, San Jacinto, CA 92583-5517 | 2007-01-19 |
| Street Address |
11980 MOUNT VERNON AVE |
| City | GRAND TERRACE |
| State | CA |
| Zip Code | 92313-5172 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285614750 | Ramon U. Ferra | Obstetrics & Gynecology | 11980 Mount Vernon Ave, Grand Terrace, CA 92313-5172 | 2006-01-19 |
| 1205440773 | Riverside-san Bernardino County Indian Health, Inc | Non-emergency Medical Transport (VAN) | 11980 Mount Vernon Ave, Grand Terrace, CA 92313-5172 | 2020-09-02 |
| 1396217113 | Gabrielle Hernandez | Driver | 11980 Mount Vernon Ave, Grand Terrace, CA 92313-5172 | 2018-12-18 |
| 1114498037 | Vivian Nicole Martinez | Driver | 11980 Mount Vernon Ave, Grand Terrace, CA 92313-5172 | 2018-12-17 |
| 1245706563 | Tina Marie Sanchez Lincourt | Psychologist | 11980 Mount Vernon Ave, Grand Terrace, CA 92313-5172 | 2018-10-15 |
| 1891169249 | Riverside-san Bernardino County Indian Health, Inc. | Clinic/Center | 11980 Mount Vernon Ave, Grand Terrace, CA 92313-5172 | 2015-11-23 |
| 1972924553 | Amber Joy Smith | Marriage & Family Therapist | 11980 Mount Vernon Ave, Grand Terrace, CA 92313-5172 | 2013-12-26 |
| 1225463409 | Catherine Jameson Lee Kelly | Psychologist | 11980 Mount Vernon Ave, Grand Terrace, CA 92313-5172 | 2013-09-06 |
| 1750721692 | Dinh Le Quang Nguyen | Family Medicine | 11980 Mount Vernon Ave, Grand Terrace, CA 92313-5172 | 2013-06-25 |
| 1104108109 | Sanjiwani Meharda | Preventive Medicine | 11980 Mount Vernon Ave, Grand Terrace, CA 92313-5172 | 2011-09-15 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427321322 | Noelle Angelica Leon | Technician, Pathology | 22799 Desoto Street, Grand Terrace, CA 92313 | 2012-02-23 |
| 1487885497 | Impression Healthcare Services, Inc. | Community Based Residential Treatment Facility, Mental Illness | 22573 Barton Rd., Grand Terrace, CA 92313 | 2009-08-07 |
| 1528230869 | Patricia Zappia | Specialist | 22927 Grand Terrace Road, Grand Terrace, CA 92313 | 2008-03-27 |
| 1558579755 | Robert Mitchell Norman | Psychiatry & Neurology | Riverside San Bernardino Indian Health, Inc., 11980 Mt Vernon Ave, Grand Terrace, CA 92313 | 2007-05-19 |
| 1770725939 | Jarco Medical Group, LLC | Clinic/Center | 12030 La Cadena Dr, Grand Terrace, CA 92313-3613 | 2009-04-01 |
| 1376015164 | Trescina Michelle Hernandez | Assistant Behavior Analyst | 22887 Brentwood St, Grand Terrace, CA 92313-4908 | 2018-12-18 |
| 1811037492 | Jonbec Care Inc. | Intermediate Care Facility, Mentally Retarded | 11868 Canal St, Grand Terrace, CA 92313-4941 | 2007-02-06 |
| 1922028406 | Heather Carriedo | Pediatrics | 23251 Glendora Dr, Grand Terrace, CA 92313-4965 | 2006-07-20 |
| 1760683866 | Emeritus Corporation | Alzheimer Center (Dementia Center) | 22325 Barton Rd, Grand Terrace, CA 92313-5006 | 2007-05-29 |
| 1780985747 | Jerome Mendiola Ocampo | Dentist | 22421 Barton Rd # 291, Grand Terrace, CA 92313-5008 | 2010-11-08 |
| Find all providers in zip 92313 | ||||
| Taxonomy Code | 261QF0400X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Federally Qualified Health Center (FQHC) |
| Definition to come... |
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| Find all providers with the same taxonomy | ||||
| City | GRAND TERRACE |
| Zip Code | 92313 |
Please comment or provide details below to improve the information on RIVERSIDE-SAN BERNARDINO COUNTY INDIAN HEALTH, INC..
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.