=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598560492
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | IMPERIAL VALLEY HEALTHCARE DISTRICT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/14/2025
-----------------------------------------------------
Last Update Date | 02/14/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 565 MAIN ST
-----------------------------------------------------
City | BRAWLEY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92227-2423
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-344-5565
-----------------------------------------------------
Fax | 760-344-5656
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 207 W LEGION RD
-----------------------------------------------------
City | BRAWLEY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92227-7780
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-351-3341
-----------------------------------------------------
Fax | 760-351-3155
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF FINANCIAL OFFICER
-----------------------------------------------------
Name | CARLY LOPER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 760-351-3594
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR1300X
-----------------------------------------------------
Taxonomy Name | Rural Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------