Healthcare Provider Details

I. General information

NPI: 1174048680
Provider Name (Legal Business Name): CANCER RESOURCE CENTER OF THE DESERT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2017
Last Update Date: 08/02/2024
Certification Date: 08/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

444 S 8TH ST STE B3
EL CENTRO CA
92243-3236
US

IV. Provider business mailing address

PO BOX 513
EL CENTRO CA
92244-0513
US

V. Phone/Fax

Practice location:
  • Phone: 760-353-6571
  • Fax: 760-353-6281
Mailing address:
  • Phone: 760-353-6571
  • Fax: 760-353-6281

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number State

VIII. Authorized Official

Name: HELEN G PALOMINO
Title or Position: CEO
Credential: LCSW
Phone: 760-353-6571