Provider Demographics
NPI:1659533735
Name:PARTNER HEALTHCARE INC
Entity Type:Organization
Organization Name:PARTNER HEALTHCARE INC
Other - Org Name:INLAND VALLEY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-590-6666
Mailing Address - Street 1:4761 ARROW HWY
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:CA
Mailing Address - Zip Code:91763-1209
Mailing Address - Country:US
Mailing Address - Phone:909-625-2525
Mailing Address - Fax:909-625-2500
Practice Address - Street 1:4761 ARROW HWY
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:CA
Practice Address - Zip Code:91763-1209
Practice Address - Country:US
Practice Address - Phone:909-625-2525
Practice Address - Fax:909-625-2500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-30
Last Update Date:2011-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY490703336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1659533735Medicaid
5630733OtherNCPDP PROVIDER IDENTIFICATION NUMBER
CA1659533735Medicaid