NPIMap

Organization Active NPI

Shady Glen Facility

  • Developmental Disabilities Clinic/Center
  • San Bernardino, CA
National Provider Identifier
1003046566
Registry record updated Jul 29, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Developmental Disabilities Clinic/CenterTaxonomy code 261QD1600X
License
360911227 Issued in CA
Legal business name
SHADY GLEN FACILITY
Practice address
2571 Shady Glen LN
San Bernardino, CA 92408-4174
Phone
(909) 783-8806
NPI assigned
Jul 19, 2009
Organization subpart
Yes
Parent organization
BRIDGES IN COMMUNICATIONS, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 29, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Miss Patricia Stone
Title
Administrator
Phone
(909) 910-9604

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Developmental Disabilities Clinic/Center 261QD1600X 360911227 CA Primary

Addresses

Primary practice location

2571 Shady Glen LN
San Bernardino, CA 92408-4174

Mailing address

2571 Shady Glen LN
San Bernardino, CA 92408-4174
Phone (909) 783-8806

National Provider Directory

National Provider Directory
Tax ID family
Garden Home Facility4 organizations share this tax ID, including this one
Part of
Garden Home Facility

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1247961600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1248825600000",
    "number": "1003046566",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2571 SHADY GLEN LN",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924084174",
            "telephone_number": "909-783-8806"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2571 SHADY GLEN LN",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924084174",
            "telephone_number": "909-783-8806"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHADY GLEN FACILITY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BRIDGES IN COMMUNICATIONS, INC",
        "enumeration_date": "2009-07-19",
        "last_updated": "2009-07-29",
        "status": "A",
        "authorized_official_last_name": "STONE",
        "authorized_official_first_name": "PATRICIA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "909-910-9604",
        "authorized_official_name_prefix": "Miss"
    },
    "taxonomies": [
        {
            "code": "261QD1600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Developmental Disabilities",
            "state": "CA",
            "license": "360911227",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Bernardino, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.