Provider Demographics
NPI:1104889930
Name:IMPERIAL VALLEY HOME HEALTH CARE CORPORATION
Entity type:Organization
Organization Name:IMPERIAL VALLEY HOME HEALTH CARE CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CATALINA
Authorized Official - Middle Name:A
Authorized Official - Last Name:SANTILLAN
Authorized Official - Suffix:
Authorized Official - Credentials:BSBA
Authorized Official - Phone:760-344-9180
Mailing Address - Street 1:630 S BRAWLEY AVE STE 5
Mailing Address - Street 2:
Mailing Address - City:BRAWLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92227-3107
Mailing Address - Country:US
Mailing Address - Phone:760-344-9180
Mailing Address - Fax:760-344-8181
Practice Address - Street 1:630 S BRAWLEY AVE STE 5
Practice Address - Street 2:
Practice Address - City:BRAWLEY
Practice Address - State:CA
Practice Address - Zip Code:92227-3107
Practice Address - Country:US
Practice Address - Phone:760-344-9180
Practice Address - Fax:760-344-8181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-11
Last Update Date:2011-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA080000454251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHHA07415FMedicaid
CA057415Medicare ID - Type Unspecified