Healthcare Provider Details

I. General information

NPI: 1982279535
Provider Name (Legal Business Name): IMPERIAL CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2021
Last Update Date: 05/26/2021
Certification Date: 05/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 S IMPERIAL AVE
EL CENTRO CA
92243-4208
US

IV. Provider business mailing address

1700 S IMPERIAL AVE
EL CENTRO CA
92243-4208
US

V. Phone/Fax

Practice location:
  • Phone: 760-352-8471
  • Fax:
Mailing address:
  • Phone: 760-352-8471
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: SCOTT KIRBY
Title or Position: MANAGER
Credential:
Phone: 619-201-5888