Healthcare Provider Details

I. General information

NPI: 1982080446
Provider Name (Legal Business Name): C.H.A.R.L.E.E. FAMILY CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2015
Last Update Date: 09/22/2025
Certification Date: 09/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

495 E ORANGE AVENUE
EL CENTRO CA
92243-2744
US

IV. Provider business mailing address

136 E 6TH STREET
BEAUMONT CA
92223-2146
US

V. Phone/Fax

Practice location:
  • Phone: 760-353-6151
  • Fax: 760-353-6152
Mailing address:
  • Phone: 951-845-3588
  • Fax: 951-845-3544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number State

VIII. Authorized Official

Name: DR. JASON CARL JIMENEZ
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 909-379-9680