Provider Demographics
NPI:1275760589
Name:SAN BERNARDINO COUNTY DEPARTMENT OF BEHAVIORAL HEALTH
Entity Type:Organization
Organization Name:SAN BERNARDINO COUNTY DEPARTMENT OF BEHAVIORAL HEALTH
Other - Org Name:GATEWAY RYEF
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ALLAN
Authorized Official - Middle Name:
Authorized Official - Last Name:RAWLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-382-3133
Mailing Address - Street 1:268 W HOSPITALITY LN
Mailing Address - Street 2:SUITE 400
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92415-1028
Mailing Address - Country:US
Mailing Address - Phone:909-382-3133
Mailing Address - Fax:909-382-3105
Practice Address - Street 1:740 E GILBERT ST
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92415-1003
Practice Address - Country:US
Practice Address - Phone:909-387-7793
Practice Address - Fax:909-387-7386
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-12
Last Update Date:2012-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health