Provider Demographics
NPI:1508642083
Name:CANCER RESOURCE CENTER OF THE DESERT
Entity Type:Organization
Organization Name:CANCER RESOURCE CENTER OF THE DESERT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:HELEN
Authorized Official - Middle Name:
Authorized Official - Last Name:PALOMINO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:760-353-6571
Mailing Address - Street 1:444 S 8TH ST STE B3
Mailing Address - Street 2:
Mailing Address - City:EL CENTRO
Mailing Address - State:CA
Mailing Address - Zip Code:92243-3236
Mailing Address - Country:US
Mailing Address - Phone:760-353-6571
Mailing Address - Fax:760-353-6281
Practice Address - Street 1:444 S. 8TH STREET
Practice Address - Street 2:SUITE B3
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243
Practice Address - Country:US
Practice Address - Phone:760-353-6571
Practice Address - Fax:760-353-6281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-31
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No172V00000XOther Service ProvidersCommunity Health WorkerGroup - Multi-Specialty
No251B00000XAgenciesCase Management
No251X00000XAgenciesSupports Brokerage
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7617542Medicaid