Healthcare Provider Details

I. General information

NPI: 1922356369
Provider Name (Legal Business Name): TRI-STATE COMMUNITY HEALTHCARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2012
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 W BROADWAY ST
NEEDLES CA
92363-2729
US

IV. Provider business mailing address

820 W BROADWAY ST
NEEDLES CA
92363-2729
US

V. Phone/Fax

Practice location:
  • Phone: 760-326-0222
  • Fax: 760-326-0221
Mailing address:
  • Phone: 760-326-0222
  • Fax: 760-326-0221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number StateCA

VIII. Authorized Official

Name: ARAM MANOUKIAN
Title or Position: CEO
Credential:
Phone: 818-652-6612