Healthcare Provider Details

I. General information

NPI: 1104889930
Provider Name (Legal Business Name): IMPERIAL VALLEY HOME HEALTH CARE CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2006
Last Update Date: 02/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 S BRAWLEY AVE STE 5
BRAWLEY CA
92227-3107
US

IV. Provider business mailing address

630 S BRAWLEY AVE STE 5
BRAWLEY CA
92227-3107
US

V. Phone/Fax

Practice location:
  • Phone: 760-344-9180
  • Fax: 760-344-8181
Mailing address:
  • Phone: 760-344-9180
  • Fax: 760-344-8181

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number080000454
License Number StateCA

VIII. Authorized Official

Name: MS. CATALINA A SANTILLAN
Title or Position: ADMINISTRATOR
Credential: BSBA
Phone: 760-344-9180