Provider Demographics
NPI:1689173197
Name:CENTRAL NEIGHBORHOOD HEALTH FOUNDATION - BASE LINE SAN BERNARDINO
Entity Type:Organization
Organization Name:CENTRAL NEIGHBORHOOD HEALTH FOUNDATION - BASE LINE SAN BERNARDINO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:NUSRATH
Authorized Official - Middle Name:FATIMA
Authorized Official - Last Name:JAHANGIR
Authorized Official - Suffix:
Authorized Official - Credentials:VN
Authorized Official - Phone:310-962-8970
Mailing Address - Street 1:1574 W BASE LINE ST
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92411-1777
Mailing Address - Country:US
Mailing Address - Phone:909-386-1880
Mailing Address - Fax:
Practice Address - Street 1:1574 W BASE LINE ST
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92411-1777
Practice Address - Country:US
Practice Address - Phone:909-386-1880
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTRAL NEIGHBORHOOD HEALTH FOUNDATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-02-09
Last Update Date:2018-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health