Healthcare Provider Details

I. General information

NPI: 1063819019
Provider Name (Legal Business Name): COMMUNITY HEALTHCARE PARTNER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2014
Last Update Date: 11/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 BAILEY AVE
NEEDLES CA
92363-3103
US

IV. Provider business mailing address

1401 BAILEY AVE
NEEDLES CA
92363-3103
US

V. Phone/Fax

Practice location:
  • Phone: 760-326-7160
  • Fax: 760-326-7292
Mailing address:
  • Phone: 760-326-7160
  • Fax: 760-326-7292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number240000227
License Number StateCA

VIII. Authorized Official

Name: MR. STEVE KELLEY LOPEZ
Title or Position: ADMINISTRATOR/CEO
Credential:
Phone: 760-326-7160