Provider Demographics
NPI:1548347727
Name:SAN BERNARDINO COUNTY/CCS
Entity type:Organization
Organization Name:SAN BERNARDINO COUNTY/CCS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PUBLIC HEALTH OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:MAXWELL
Authorized Official - Middle Name:
Authorized Official - Last Name:OHIKHUARE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-387-6219
Mailing Address - Street 1:451 E VANDERBILT WAY
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92408-3641
Mailing Address - Country:US
Mailing Address - Phone:909-387-6218
Mailing Address - Fax:
Practice Address - Street 1:4777 N STATE ST
Practice Address - Street 2:CARMACK MTU
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92407-3321
Practice Address - Country:US
Practice Address - Phone:909-880-6611
Practice Address - Fax:909-887-7537
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAN BERNARDINO COUNTY PUBLIC HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-01
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Multi-Specialty
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Multi-Specialty
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACCS00088FOtherREHAB CLINIC