Provider Demographics
NPI:1851576888
Name:BEAR VALLEY COMMUNITY HEALTH CARE DISTRICT
Entity Type:Organization
Organization Name:BEAR VALLEY COMMUNITY HEALTH CARE DISTRICT
Other - Org Name:FAMILY HEALTH CENTER RHC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INTERM CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:GARTH
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMBLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-866-6501
Mailing Address - Street 1:P.O. BOX 1649
Mailing Address - Street 2:
Mailing Address - City:BIG BEAR LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:92315-1649
Mailing Address - Country:US
Mailing Address - Phone:909-866-6501
Mailing Address - Fax:909-878-8284
Practice Address - Street 1:41820 GARSTIN DRIVE
Practice Address - Street 2:
Practice Address - City:BIG BEAR LAKE
Practice Address - State:CA
Practice Address - Zip Code:92315-1649
Practice Address - Country:US
Practice Address - Phone:909-878-8246
Practice Address - Fax:909-878-8294
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-09
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24000011261QR1300X
CA261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1851576888Medicaid
CAHAP18564FMedicaid
CARHM18564FMedicaid
CA1851576888Medicaid