Provider Demographics
NPI:1013218643
Name:CATHOLIC CHARITIES SAN BERNARDINO/RIVERSIDE
Entity Type:Organization
Organization Name:CATHOLIC CHARITIES SAN BERNARDINO/RIVERSIDE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/EXECUTIVE VICE-PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KEN
Authorized Official - Middle Name:F
Authorized Official - Last Name:SAWA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:909-388-1239
Mailing Address - Street 1:1450 N D ST
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92405-4739
Mailing Address - Country:US
Mailing Address - Phone:909-388-1239
Mailing Address - Fax:909-384-1130
Practice Address - Street 1:23623 SUNNYMEAD BLVD
Practice Address - Street 2:SUITE E
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92553-3083
Practice Address - Country:US
Practice Address - Phone:951-924-9964
Practice Address - Fax:951-924-9997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-12
Last Update Date:2010-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health