Provider Demographics
NPI:1437122769
Name:PIONEERS MEMORIAL HEALTHCARE DISTRICT
Entity Type:Organization
Organization Name:PIONEERS MEMORIAL HEALTHCARE DISTRICT
Other - Org Name:CALEXICO HEALTH CENTER RHC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSOCIATE ADMIN FINANCE & CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:HECKATHORNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-351-3590
Mailing Address - Street 1:207 W LEGION RD
Mailing Address - Street 2:
Mailing Address - City:BRAWLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92227-7780
Mailing Address - Country:US
Mailing Address - Phone:760-351-3590
Mailing Address - Fax:760-351-3312
Practice Address - Street 1:450 E BIRCH ST
Practice Address - Street 2:
Practice Address - City:CALEXICO
Practice Address - State:CA
Practice Address - Zip Code:92231-2375
Practice Address - Country:US
Practice Address - Phone:760-768-6262
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-08
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZC1301ZOtherBLUE SHIELD RHC
AZ021709Medicaid
CARHM18607FMedicaid
CA058607OtherBLUE CROSS RHC
CA058607OtherBLUE CROSS RHC