Healthcare Provider Details

I. General information

NPI: 1174125892
Provider Name (Legal Business Name): TRI-STATE COMMUNITY HEALTHCARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2020
Last Update Date: 07/15/2025
Certification Date: 07/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2311 S CASINO DR STE A-3
LAUGHLIN NV
89029-1535
US

IV. Provider business mailing address

1535 E COLORADO ST
GLENDALE CA
91205-1513
US

V. Phone/Fax

Practice location:
  • Phone: 702-508-0308
  • Fax: 702-508-9544
Mailing address:
  • Phone: 323-297-0884
  • Fax: 323-274-4604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

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