Provider Demographics
NPI:1508944075
Name:SAN BERNARDINO COUNTY PUBLIC HEALTH DEPT.
Entity Type:Organization
Organization Name:SAN BERNARDINO COUNTY PUBLIC HEALTH DEPT.
Other - Org Name:CALIFORNIA CHILDREN'S SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:HEALTH OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:OHIKHUARE
Authorized Official - Middle Name:
Authorized Official - Last Name:MAXWELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-387-6218
Mailing Address - Street 1:351 N MOUNTAIN VIEW AVE
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92415-0010
Mailing Address - Country:US
Mailing Address - Phone:909-387-6218
Mailing Address - Fax:
Practice Address - Street 1:3380 AVALON
Practice Address - Street 2:YUCCA MESA MTU
Practice Address - City:YUCCA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92286-0042
Practice Address - Country:US
Practice Address - Phone:760-369-6315
Practice Address - Fax:760-369-1237
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAN BERNARDINO COUNTY PUBLIC HEALTH DEPT.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-01
Last Update Date:2015-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Multi-Specialty
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Multi-Specialty
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACCS00116FOtherREHAB CLINIC