Provider Demographics
NPI:1831490465
Name:CATHOLIC CHARITIES SAN BERNARDINO/RIVERSIDE
Entity Type:Organization
Organization Name:CATHOLIC CHARITIES SAN BERNARDINO/RIVERSIDE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/EXECUTIVE VICE-PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KEN
Authorized Official - Middle Name:F
Authorized Official - Last Name:SAWA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:909-388-1239
Mailing Address - Street 1:1450 N D ST
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92405-4739
Mailing Address - Country:US
Mailing Address - Phone:909-388-1239
Mailing Address - Fax:909-384-1130
Practice Address - Street 1:81626 US HIGHWAY 111
Practice Address - Street 2:
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92201-5413
Practice Address - Country:US
Practice Address - Phone:760-342-0157
Practice Address - Fax:760-342-0341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-12
Last Update Date:2010-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health