| Inland Empire Behavioral Group Nursing Corporation | |
|
11801 Pierce St Ste 200 Riverside CA 92505-3907 | |
| (909) 429-3244 | |
| (909) 981-0821 |
| Full Name | Inland Empire Behavioral Group Nursing Corporation |
|---|---|
| Speciality | Clinic/Center |
| Location | 11801 Pierce St Ste 200, Riverside, California |
| Authorized Official Name and Position | Khadija Hamuche Hamisi (CEO) |
| Authorized Official Contact | 9094293224 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Inland Empire Behavioral Group Nursing Corporation 1747 Steinman St Riverside CA 92507-7809 Ph: (909) 429-3244 | Inland Empire Behavioral Group Nursing Corporation 11801 Pierce St Ste 200 Riverside CA 92505-3907 Ph: (909) 429-3244 |
| NPI Number | 1104570282 |
|---|---|
| Provider Enumeration Date | 02/08/2022 |
| Last Update Date | 04/23/2024 |
| Certification Date | 04/23/2024 |
| Medicare PECOS PAC ID | 4880089390 |
|---|---|
| Medicare Enrollment ID | O20220321001022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104570282 | NPI | - | NPPES |
| Provider Name | Khadija H Hamisi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1225360498 PECOS PAC ID: 4385874460 Enrollment ID: I20140312000229 |
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