Basic Information
| Provider Information | |||||||||
| NPI: | 1659786721 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | INLAND BEHAVIORAL AND HEALTH SERVICES, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | IBHS PHARMACY | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 956 | ||||||||
| Address2: | |||||||||
| City: | BANNING | ||||||||
| State: | CA | ||||||||
| PostalCode: | 922200007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9097088158 | ||||||||
| FaxNumber: | 9098883627 | ||||||||
| Practice Location | |||||||||
| Address1: | 1070 E RAMSEY ST STE C | ||||||||
| Address2: | |||||||||
| City: | BANNING | ||||||||
| State: | CA | ||||||||
| PostalCode: | 922205924 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9518462560 | ||||||||
| FaxNumber: | 9518492310 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2014 | ||||||||
| LastUpdateDate: | 03/16/2016 | ||||||||
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| AuthorizedOfficialLastName: | LINDSEY | ||||||||
| AuthorizedOfficialFirstName: | TEMETRY | ||||||||
| AuthorizedOfficialMiddleName: | ANN | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO/PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9097088158 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3336C0003X | PHY51684 | CA | Y | Suppliers | Pharmacy | Community/Retail Pharmacy |
No ID Information.