Provider Demographics
NPI:1679200976
Name:RIVERSIDE SAN BERNARDINO COUNTY INDIAN HEALTH INC
Entity Type:Organization
Organization Name:RIVERSIDE SAN BERNARDINO COUNTY INDIAN HEALTH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-864-1097
Mailing Address - Street 1:11980 MOUNT VERNON AVE
Mailing Address - Street 2:
Mailing Address - City:GRAND TERRACE
Mailing Address - State:CA
Mailing Address - Zip Code:92313-5172
Mailing Address - Country:US
Mailing Address - Phone:909-864-1097
Mailing Address - Fax:951-225-6879
Practice Address - Street 1:66655 MARTINEZ RD
Practice Address - Street 2:
Practice Address - City:THERMAL
Practice Address - State:CA
Practice Address - Zip Code:92274-9007
Practice Address - Country:US
Practice Address - Phone:760-397-4476
Practice Address - Fax:951-225-6879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-05
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332800000XSuppliersIndian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
No333600000XSuppliersPharmacy