Riverside-San Bernardino County Indian Health, INC
Clinic/Center, Federally Qualified Health Center (FQHC) in Mountain Center, CA. Organization (NPI-2).
NPI number1366028086
StatusActive
Last updated in NPPESSep 16, 2021
Details
- NPI
- 1366028086
- Entity type
- Organization (NPI-2)
- Legal business name
- Riverside-San Bernardino County Indian Health, INC
- Organization subpart
- No
- Enumeration date
- Mar 23, 2021
- Certification date
- Sep 16, 2021
- Last updated
- Sep 16, 2021
Medicare and OIG
- Medicare enrolled (PECOS)
- Yes · PART A PROVIDER - FEDERALLY QUALIFIED HEALTH CENTER (FQHC)
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QF0400X | Clinic/Center, Federally Qualified Health Center (FQHC) | – | – | Yes |
Other names
- Santa Rosa Indian Health Clinic (Doing Business As)
Practice location
65175 St. Highway 74Mountain Center, CA 92561-9231
Phone 951-823-8882 · Fax 951-225-6879
Mailing address
11980 Mount Vernon AveGrand Terrace, CA 92313-5172
Phone 909-864-1097 · Fax 951-225-6879
Authorized official
William Thomsen
Ceo
9098641097
Is something wrong?
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