NPIMap

Organization Active NPI

Inland Empire Behavioral Group Nursing Corporation

  • Multi-Specialty Clinic/Center
  • Riverside, CA
National Provider Identifier
1104570282
Registry record updated Apr 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
INLAND EMPIRE BEHAVIORAL GROUP NURSING CORPORATION
Practice address
11801 Pierce St Ste 200
Riverside, CA 92505-3907
Phone
(909) 429-3244
Fax
(909) 981-0821
NPI assigned
Feb 8, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 23, 2024

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

Authorized official

Name
Khadija Hamuche Hamisi, DNPNPI 1225360498
Title
Ceo
Phone
(909) 429-3224

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0800X
Multi-Specialty Clinic/Center 261QM1300X Primary
Psychiatric/Mental Health Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LP0808X

Addresses

Primary practice location

11801 Pierce St Ste 200
Riverside, CA 92505-3907

Mailing address

1747 Steinman St
Riverside, CA 92507-7809
Phone (909) 429-3244

Other practice location 1

1003 E Cooley Dr Ste 211
Colton, CA 92324-3907
Phone (909) 429-3244

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220321001022 CA Part B Supplier - Clinic/Group Practice 4880089390 Receives reassigned benefits from 10 practitioners
Practice locations: Colton, CA; Riverside, CA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1644278400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1713830400000",
    "number": "1104570282",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1747 STEINMAN ST",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925077809",
            "telephone_number": "909-429-3244"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11801 PIERCE ST STE 200",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925053907",
            "telephone_number": "909-429-3244",
            "fax_number": "909-981-0821"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1003 E Cooley Dr Ste 211",
            "address_purpose": "LOCATION",
            "city": "Colton",
            "state": "CA",
            "postal_code": "923243907",
            "country_code": "US",
            "telephone_number": "909-429-3244",
            "fax_number": "909-981-0821",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "INLAND EMPIRE BEHAVIORAL GROUP NURSING CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-02-08",
        "last_updated": "2024-04-23",
        "certification_date": "2024-04-23",
        "status": "A",
        "authorized_official_last_name": "HAMISI",
        "authorized_official_first_name": "KHADIJA",
        "authorized_official_middle_name": "HAMUCHE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "909-429-3224",
        "authorized_official_credential": "DNP"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Riverside, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.