Provider Demographics
NPI:1952308009
Name:COMMUNITY HEALTH SYSTEMS, INC.
Entity Type:Organization
Organization Name:COMMUNITY HEALTH SYSTEMS, INC.
Other - Org Name:INLAND EMPIRE COMMUNITY HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:BOBBY
Authorized Official - Middle Name:
Authorized Official - Last Name:VASCOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-877-1818
Mailing Address - Street 1:18601 VALLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:CA
Mailing Address - Zip Code:92316-1831
Mailing Address - Country:US
Mailing Address - Phone:909-877-1818
Mailing Address - Fax:909-746-0400
Practice Address - Street 1:18601 VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:CA
Practice Address - Zip Code:92316-1831
Practice Address - Country:US
Practice Address - Phone:909-877-1818
Practice Address - Fax:909-746-0400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QF0400X, 261QF0400X, 261QF0400X, 261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG98054-01OtherDELTA DENTAL
CAG98054-03OtherDELTA DENTAL
CAHAP70865FOtherFAMILY PACT
CAHAP70324FOtherFAMILY PACT
CAFHC70275GMedicaid
CAFHC70324FMedicaid
CAFHC71040FMedicaid
CAG98054-02OtherDELTA DENTAL
CAHAP70275GOtherFAMILY PACT
CAFHC70865FMedicaid
CA55183Medicare ID - Type Unspecified
CAHAP70865FOtherFAMILY PACT
CAFHC70275GMedicaid