Healthcare Provider Details

I. General information

NPI: 1194705202
Provider Name (Legal Business Name): PALO VERDE HEALTH CARE DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2006
Last Update Date: 11/26/2024
Certification Date: 11/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 N 1ST ST
BLYTHE CA
92225-1702
US

IV. Provider business mailing address

250 N 1ST ST
BLYTHE CA
92225-1702
US

V. Phone/Fax

Practice location:
  • Phone: 760-922-4115
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number250000184
License Number StateCA

VIII. Authorized Official

Name: SANDRA J ANAYA
Title or Position: CEO
Credential: RN
Phone: 760-922-4115