Provider Demographics
NPI:1275809006
Name:BORREGO COMMUNITY HEALTH FOUNDATION
Entity Type:Organization
Organization Name:BORREGO COMMUNITY HEALTH FOUNDATION
Other - Org Name:WOOLCOTT DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF MANAGED CARE OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:DEW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-344-2815
Mailing Address - Street 1:PO BOX 2369
Mailing Address - Street 2:
Mailing Address - City:BORREGO SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92004-2369
Mailing Address - Country:US
Mailing Address - Phone:760-767-5051
Mailing Address - Fax:760-767-4552
Practice Address - Street 1:590 PALM CANYON DRIVE
Practice Address - Street 2:SUITE 212
Practice Address - City:BORREGO SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92004
Practice Address - Country:US
Practice Address - Phone:760-767-5112
Practice Address - Fax:760-767-5613
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-27
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)