Provider Demographics
NPI:1437668720
Name:IMPERIAL MANOR SKILLED NURSING INC
Entity Type:Organization
Organization Name:IMPERIAL MANOR SKILLED NURSING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF NURSING
Authorized Official - Prefix:
Authorized Official - First Name:VENUS
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:760-355-2858
Mailing Address - Street 1:1590 S IMPERIAL AVE
Mailing Address - Street 2:
Mailing Address - City:EL CENTRO
Mailing Address - State:CA
Mailing Address - Zip Code:92243-4241
Mailing Address - Country:US
Mailing Address - Phone:1760-352-2551
Mailing Address - Fax:760-352-3022
Practice Address - Street 1:100 E 2ND ST
Practice Address - Street 2:
Practice Address - City:IMPERIAL
Practice Address - State:CA
Practice Address - Zip Code:92251-1813
Practice Address - Country:US
Practice Address - Phone:760-355-2858
Practice Address - Fax:760-355-1221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-29
Last Update Date:2018-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA090000061314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility