Provider Demographics
NPI:1780005058
Name:BEHAVIORAL AWARENESS CENTER OF SAN BERNARDINO
Entity Type:Organization
Organization Name:BEHAVIORAL AWARENESS CENTER OF SAN BERNARDINO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICE
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-947-2600
Mailing Address - Street 1:15278 MAIN ST
Mailing Address - Street 2:STE C
Mailing Address - City:HESPERIA
Mailing Address - State:CA
Mailing Address - Zip Code:92345-3300
Mailing Address - Country:US
Mailing Address - Phone:760-947-2400
Mailing Address - Fax:
Practice Address - Street 1:15278 MAIN ST
Practice Address - Street 2:STE C
Practice Address - City:HESPERIA
Practice Address - State:CA
Practice Address - Zip Code:92345-3300
Practice Address - Country:US
Practice Address - Phone:760-947-2400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-03
Last Update Date:2014-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15947251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health