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General NPI Number Information
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NPI Number | 1336646397
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Entity Type | Organization
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Legal Business Name | TRI-STATE COMMUNITY HEALTHCARE CENTER
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Dates
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Enumeration Date | 04/06/2018
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Last Update Date | 04/06/2018
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Provider Practice Location Address
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Address Line | 11888 BARTLETT AVE
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City | ADELANTO
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State | CA
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Zip | 92301-1709
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Country | US
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Telephone | 760-326-0222
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Fax |
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Provider Business Mailing Address
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Address Line | 1402 BAILEY AVE
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City | NEEDLES
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State | CA
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Zip | 92363-3104
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | ARAM MANOUKIAN
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Credential |
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Telephone | 760-326-0222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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