Provider Demographics
NPI:1932383148
Name:INLAND HEALTHCARE GROUP
Entity Type:Organization
Organization Name:INLAND HEALTHCARE GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:PERKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-335-7171
Mailing Address - Street 1:1980 ORANGE TREE LN
Mailing Address - Street 2:SUITE 200
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92374-4534
Mailing Address - Country:US
Mailing Address - Phone:909-335-7171
Mailing Address - Fax:909-335-7140
Practice Address - Street 1:17171 FOOTHILL BLVD.
Practice Address - Street 2:SUITE E
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92335
Practice Address - Country:US
Practice Address - Phone:909-356-5757
Practice Address - Fax:909-356-5608
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-24
Last Update Date:2007-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0062061Medicaid
CAGR0062061Medicaid