Provider Demographics
NPI:1518136787
Name:INLAND HEALTHCARE GROUP
Entity Type:Organization
Organization Name:INLAND HEALTHCARE GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:PERKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-335-7171
Mailing Address - Street 1:PO BOX 10488
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92423-0488
Mailing Address - Country:US
Mailing Address - Phone:888-344-9111
Mailing Address - Fax:909-335-7130
Practice Address - Street 1:7430 CHERRY AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92336-4255
Practice Address - Country:US
Practice Address - Phone:909-829-4680
Practice Address - Fax:909-854-0260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-21
Last Update Date:2009-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1518136787Medicaid
CA1871543850Medicaid
CA1518136787Medicaid
CAG67751Medicare UPIN
CAF64387Medicare UPIN