Healthcare Provider Details

I. General information

NPI: 1396651444
Provider Name (Legal Business Name): TRI-STATE COMMUNITY HEALTHCARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 N SAN JACINTO ST STE P
HEMET CA
92543-3154
US

IV. Provider business mailing address

540 N SAN JACINTO ST STE P
HEMET CA
92543-3154
US

V. Phone/Fax

Practice location:
  • Phone: 951-651-1006
  • Fax: 213-634-7903
Mailing address:
  • Phone: 951-651-1006
  • Fax: 213-634-7903

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ARAM MANOUKIAN
Title or Position: CEO
Credential:
Phone: 760-326-0222