Provider Demographics
NPI:1881703957
Name:SAN BERNARDINO MOUNTAINS COMMUNITY HOSPITAL DISTRICT
Entity type:Organization
Organization Name:SAN BERNARDINO MOUNTAINS COMMUNITY HOSPITAL DISTRICT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:YVONNE
Authorized Official - Middle Name:D
Authorized Official - Last Name:WAGGENER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-336-3651
Mailing Address - Street 1:PO BOX 70
Mailing Address - Street 2:
Mailing Address - City:LAKE ARROWHEAD
Mailing Address - State:CA
Mailing Address - Zip Code:92352-0070
Mailing Address - Country:US
Mailing Address - Phone:909-336-3651
Mailing Address - Fax:909-336-1179
Practice Address - Street 1:2642 PALO ALTO
Practice Address - Street 2:
Practice Address - City:RUNNING SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92382
Practice Address - Country:US
Practice Address - Phone:909-336-9715
Practice Address - Fax:909-336-5751
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAN BERNARDINO MOUNTAINS COMMUNITY HOSPITAL DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-30
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA058632Medicare UPIN
CA058632Medicare Oscar/Certification