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General NPI Number Information
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NPI Number | 1295938538
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Entity Type | Organization
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Legal Business Name | IMPERIAL VALLEY DRUG & REHAB CLINIC
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Dates
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Enumeration Date | 06/06/2007
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Last Update Date | 10/23/2013
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Provider Practice Location Address
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Address Line | 1600 S IMPERIAL AVE STE 7
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City | EL CENTRO
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State | CA
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Zip | 92243-4242
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Country | US
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Telephone | 760-312-9817
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Fax | 760-312-9824
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Provider Business Mailing Address
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Address Line | 1600 S IMPERIAL AVE STE 7
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City | EL CENTRO
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State | CA
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Zip | 92243-4242
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Country | US
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Telephone | 760-312-9817
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Fax | 760-312-9824
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Authorized Official
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Title or Position | ADMINISTRATIVE ASSISTANT
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Name | GUADALUPE SANCHEZ
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Credential |
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Telephone | 760-312-9817
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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