Basic Information
| Provider Information | |||||||||
| NPI: | 1881703957 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SAN BERNARDINO MOUNTAINS COMMUNITY HOSPITAL DISTRICT | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | RUNNING SPRINGS RURAL HEALTH CLINIC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 70 | ||||||||
| Address2: | |||||||||
| City: | LAKE ARROWHEAD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923520070 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9093363651 | ||||||||
| FaxNumber: | 9093361179 | ||||||||
| Practice Location | |||||||||
| Address1: | 2642 PALO ALTO | ||||||||
| Address2: | |||||||||
| City: | RUNNING SPRINGS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92382 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9093369715 | ||||||||
| FaxNumber: | 9093365751 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2006 | ||||||||
| LastUpdateDate: | 03/24/2017 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | HARRISON | ||||||||
| AuthorizedOfficialFirstName: | CHARLES | ||||||||
| AuthorizedOfficialMiddleName: | H. | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 9093363651 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | SAN BERNARDINO MOUNTAINS COMMUNITY HOSPITAL DISTRICT | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
No ID Information.