Provider Demographics
NPI:1578823647
Name:INLAND BEHAVIORAL AND HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:INLAND BEHAVIORAL AND HEALTH SERVICES, INC.
Other - Org Name:INLAND BEHAVIORAL AND HEALTH SERVICES, INC.
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TEMETRY
Authorized Official - Middle Name:A
Authorized Official - Last Name:LINDSEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-708-8158
Mailing Address - Street 1:1963 N E ST
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92405-3919
Mailing Address - Country:US
Mailing Address - Phone:909-881-6146
Mailing Address - Fax:909-881-3479
Practice Address - Street 1:1070 E. RAMSEY STEET
Practice Address - Street 2:
Practice Address - City:BANNING
Practice Address - State:CA
Practice Address - Zip Code:92220-0998
Practice Address - Country:US
Practice Address - Phone:951-846-2560
Practice Address - Fax:951-849-2310
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INLAND BEHAVIORAL AND HEALTH SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-05-23
Last Update Date:2017-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFHC 70520FMedicaid
CAFHC 70520FMedicaid