Provider Demographics
NPI:1255523759
Name:WHITNEY YOUNG FAMILY HEALTH CLINIC
Entity type:Organization
Organization Name:WHITNEY YOUNG FAMILY HEALTH CLINIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TEMETRY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:LINDSEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:909-881-6146
Mailing Address - Street 1:1755 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92411-2441
Mailing Address - Country:US
Mailing Address - Phone:909-386-7600
Mailing Address - Fax:909-386-7580
Practice Address - Street 1:1755 MAPLE ST
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92411-2441
Practice Address - Country:US
Practice Address - Phone:909-386-7600
Practice Address - Fax:909-386-7580
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INLAND BEHAVIORAL & HEALTH SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-08-17
Last Update Date:2015-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA240000839261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFHC70520FMedicaid
CAFHC70520FMedicaid