Healthcare Provider Details

I. General information

NPI: 1164342762
Provider Name (Legal Business Name): IMPERIAL VALLEY CARE CMHC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E 4TH ST
CALEXICO CA
92231-2714
US

IV. Provider business mailing address

200 E 4TH ST
CALEXICO CA
92231-2714
US

V. Phone/Fax

Practice location:
  • Phone: 747-836-7646
  • Fax:
Mailing address:
  • Phone: 747-836-7646
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: ANUSH MNATSAKANYAN
Title or Position: CEO
Credential:
Phone: 818-906-4466