Healthcare Provider Details

I. General information

NPI: 1437668720
Provider Name (Legal Business Name): IMPERIAL MANOR SKILLED NURSING INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2017
Last Update Date: 04/02/2025
Certification Date: 04/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E 2ND ST
IMPERIAL CA
92251-1813
US

IV. Provider business mailing address

1699 N IMPERIAL AVE
EL CENTRO CA
92243-1320
US

V. Phone/Fax

Practice location:
  • Phone: 760-355-2858
  • Fax: 760-355-1221
Mailing address:
  • Phone: 760-352-2551
  • Fax: 888-631-5150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number090000061
License Number StateCA

VIII. Authorized Official

Name: VENUS NGUYEN
Title or Position: DIRECTOR OF NURSING
Credential: FNP
Phone: 760-355-2858