NPIMap

Organization Active NPI

Whitney Young Family Health Clinic

  • Federally Qualified Health Center (FQHC)
  • San Bernardino, CA
National Provider Identifier
1255523759
Registry record updated Aug 6, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
240000839 Issued in CA
Legal business name
WHITNEY YOUNG FAMILY HEALTH CLINIC
Practice address
1755 Maple St
San Bernardino, CA 92411-2441
Phone
(909) 386-7600
Fax
(909) 386-7580
NPI assigned
Aug 17, 2007
Last updated
Aug 6, 2015By the provider in NPPES
Organization subpart
Yes
Parent organization
INLAND BEHAVIORAL & HEALTH SERVICES, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 6, 2015

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

Authorized official

Name
Dr. Temetry Ann Lindsey, PH.D.
Title
Ceo/President
Phone
(909) 881-6146

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 240000839 CA Primary

Addresses

Primary practice location

1755 Maple St
San Bernardino, CA 92411-2441

Mailing address

1755 Maple St
San Bernardino, CA 92411-2441
Phone (909) 386-7600

Other identifiers 1

IdentifierTypeStateIssuer
FHC70520FMedicaidCA

Other names 1

  • Inland Behavioral & Health Services, Inc. Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1255523759. Details of each certification follow.

  • CCN 551930 Federally qualified health center · Active · Name & address match · Details

Federally qualified health center certification: CCN 551930

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
IBHS WHITNEY YOUNG FAMILY HEALTH CLINIC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Aug 9, 2003
Last certification
Aug 9, 2003
Ownership / control type
For profit – corporation
Facility address
1755 West Maple Street
San Bernardino, CA 92411

National Provider Directory

National Provider Directory
Tax ID family
Inland Behavioral Servi6 organizations share this tax ID, including this one
Part of
Inland Behavioral Servi

Other organizations with this tax ID 5

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

Locations

1755 Maple St
Sn Bernrdno, CA 92411
Phone (909) 386-7600

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1187308800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1438819200000",
    "number": "1255523759",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1755 MAPLE ST",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924112441",
            "telephone_number": "909-386-7600",
            "fax_number": "909-386-7580"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1755 MAPLE ST",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924112441",
            "telephone_number": "909-386-7600",
            "fax_number": "909-386-7580"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WHITNEY YOUNG FAMILY HEALTH CLINIC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "INLAND BEHAVIORAL & HEALTH SERVICES, INC.",
        "enumeration_date": "2007-08-17",
        "last_updated": "2015-08-06",
        "status": "A",
        "authorized_official_last_name": "LINDSEY",
        "authorized_official_first_name": "TEMETRY",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "CEO/PRESIDENT",
        "authorized_official_telephone_number": "909-881-6146",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "CA",
            "license": "240000839",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "FHC70520F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Inland Behavioral & Health Services, Inc.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in San Bernardino, CA

Sources for this page

Verify at the official NPI Registry.