=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104889930
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | IMPERIAL VALLEY HOME HEALTH CARE CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/11/2006
-----------------------------------------------------
Last Update Date | 02/02/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 630 S BRAWLEY AVE STE 5
-----------------------------------------------------
City | BRAWLEY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92227-3107
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-344-9180
-----------------------------------------------------
Fax | 760-344-8181
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 630 S BRAWLEY AVE STE 5
-----------------------------------------------------
City | BRAWLEY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92227-3107
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-344-9180
-----------------------------------------------------
Fax | 760-344-8181
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MS. CATALINA A SANTILLAN
-----------------------------------------------------
Credential | BSBA
-----------------------------------------------------
Telephone | 760-344-9180
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 080000454
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------