Healthcare Provider Details

I. General information

NPI: 1720853237
Provider Name (Legal Business Name): HOPE COMMUNITY CARE CLINIC, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2023
Last Update Date: 11/15/2023
Certification Date: 11/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 E 3RD ST
CALEXICO CA
92231-2832
US

IV. Provider business mailing address

716 W BROADWAY
GLENDALE CA
91204-1010
US

V. Phone/Fax

Practice location:
  • Phone: 760-890-4840
  • Fax: 760-890-4841
Mailing address:
  • Phone: 818-243-9999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ANGEL SAMVALIAN
Title or Position: ADMINISTRATOR
Credential:
Phone: 818-243-9999