Provider Demographics
NPI:1518550987
Name:DEPARTMENT OF BEHAVIORAL HEALTH, SAN BERNARDINO COUNTY
Entity Type:Organization
Organization Name:DEPARTMENT OF BEHAVIORAL HEALTH, SAN BERNARDINO COUNTY
Other - Org Name:PHOENIX SUBSTANCE USE DISORDER RECOVERY SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF COMPLIANCE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:
Authorized Official - Last Name:OCHOA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-388-0879
Mailing Address - Street 1:820 E GILBERT ST
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92415-0928
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:820 E GILBERT ST
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92415-0928
Practice Address - Country:US
Practice Address - Phone:909-387-7200
Practice Address - Fax:909-387-7717
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DEPARTMENT OF BEHAVIORAL HEALTH, SAN BERNARDINO COUNTY CA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-02-17
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health