Provider Demographics
NPI:1326257759
Name:DEPARTMENT OF BEHAVIORAL HEALTH, SAN BERNARDINO COUNTY CA
Entity Type:Organization
Organization Name:DEPARTMENT OF BEHAVIORAL HEALTH, SAN BERNARDINO COUNTY CA
Other - Org Name:AGEWISE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INFORMATION TECHNOLOGY MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:DAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-388-0570
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:92415-0001
Mailing Address - Country:US
Mailing Address - Phone:909-382-3080
Mailing Address - Fax:909-382-3105
Practice Address - Street 1:850 E FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:RIALTO
Practice Address - State:CA
Practice Address - Zip Code:92376-5230
Practice Address - Country:US
Practice Address - Phone:909-382-3080
Practice Address - Fax:909-382-3105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAZZZ74743Z261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health