Provider Demographics
NPI:1073553756
Name:BEAR VALLEY COMMUNITY HEALTH CARE DISTRICT
Entity Type:Organization
Organization Name:BEAR VALLEY COMMUNITY HEALTH CARE DISTRICT
Other - Org Name:BEAR VALLEY COMMUNITY HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:GARTH
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMBLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-878-8276
Mailing Address - Street 1:PO BOX 1649
Mailing Address - Street 2:
Mailing Address - City:BIG BEAR LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:92315
Mailing Address - Country:US
Mailing Address - Phone:909-878-8276
Mailing Address - Fax:909-878-8282
Practice Address - Street 1:41870 GARSTIN DRIVE
Practice Address - Street 2:
Practice Address - City:BIG BEAR LAKE
Practice Address - State:CA
Practice Address - Zip Code:92315
Practice Address - Country:US
Practice Address - Phone:909-878-8276
Practice Address - Fax:909-878-8282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-08
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA240000111261QR1300X, 282E00000X, 282NC0060X
3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No282E00000XHospitalsLong Term Care Hospital
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARHM08614FMedicaid
CAHSP40618JMedicaid
CALTC555468FMedicaid
CAZZZ24958ZOtherMEDICARE PROFESSIONAL
CA1073553756Medicaid
CAHSP30618JMedicaid
CARHM18564FMedicaid
CAZZZ24958ZOtherMEDICARE PROFESSIONAL
CARHM08614FMedicaid
CAHSP30618JMedicaid
CA555468Medicare Oscar/Certification
CA05Z335Medicare Oscar/Certification