Provider Demographics
NPI:1871778803
Name:BEAR VALLEY COMMUNITY HEALTHCARE DISTRICT
Entity type:Organization
Organization Name:BEAR VALLEY COMMUNITY HEALTHCARE DISTRICT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:EVAN
Authorized Official - Middle Name:
Authorized Official - Last Name:RAYNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-866-6501
Mailing Address - Street 1:PO BOX 1649
Mailing Address - Street 2:
Mailing Address - City:BIG BEAR LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:92315-1649
Mailing Address - Country:US
Mailing Address - Phone:909-878-8221
Mailing Address - Fax:909-878-8284
Practice Address - Street 1:1028 W BIG BEAR BLVD
Practice Address - Street 2:
Practice Address - City:BIG BEAR CITY
Practice Address - State:CA
Practice Address - Zip Code:92314-9562
Practice Address - Country:US
Practice Address - Phone:909-878-8221
Practice Address - Fax:909-878-8284
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-09
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA240000111261QR1300X
CA261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1871778803Medicaid
CAD497OtherMEDICAID PE
CAD497OtherMEDICAID PE