| Boys & Girls Club | |
|
1180 W 9th St San Bernardino CA 92411-2212 | |
| (909) 382-3080 | |
| (909) 382-3105 |
| Full Name | Boys & Girls Club |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 1180 W 9th St, San Bernardino, California |
| Authorized Official Name and Position | Michael J. Day (INFORMATION TECHNOLOGY MANAGER) |
| Authorized Official Contact | 9093880570 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Boys & Girls Club 268 W Hospitality Ln Suite 400 San Bernardino CA 92415-0026 Ph: (909) 382-3080 | Boys & Girls Club 1180 W 9th St San Bernardino CA 92411-2212 Ph: (909) 382-3080 |
| NPI Number | 1093926826 |
|---|---|
| Provider Enumeration Date | 05/24/2007 |
| Last Update Date | 09/24/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093926826 | NPI | - | NPPES |
| 3600036BG | Other | CA | MEDICAL PROVIDER NUMBER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | ZZZ74743Z (California) | Primary |
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