Provider Demographics
NPI:1699211151
Name:BORREGO COMMUNITY HEALTH FOUNDATION
Entity Type:Organization
Organization Name:BORREGO COMMUNITY HEALTH FOUNDATION
Other - Org Name:TROTH STREET ELEMENTARY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:HEBETS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-767-6433
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:951-710-3987
Mailing Address - Fax:
Practice Address - Street 1:5565 TROTH ST
Practice Address - Street 2:
Practice Address - City:JURUPA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:91752-2204
Practice Address - Country:US
Practice Address - Phone:951-710-3987
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BORREGO COMMUNITY HEALTH FOUNDATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-01-09
Last Update Date:2017-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)