=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114690609
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PALO VERDE HEALTHCARE DISTRICT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/29/2021
-----------------------------------------------------
Last Update Date | 11/26/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 250 N 1ST ST
-----------------------------------------------------
City | BLYTHE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92225-1702
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-922-4119
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 250 N 1ST ST
-----------------------------------------------------
City | BLYTHE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92225-1702
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-922-4119
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | SANDRA J ANAYA
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 760-922-4115
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 275N00000X
-----------------------------------------------------
Taxonomy Name | Medicare Defined Swing Bed Hospital Unit
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------