Provider Demographics
NPI:1295938538
Name:IMPERIAL VALLEY DRUG & REHAB CLINIC
Entity type:Organization
Organization Name:IMPERIAL VALLEY DRUG & REHAB CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:GUADALUPE
Authorized Official - Middle Name:
Authorized Official - Last Name:SANCHEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-312-9817
Mailing Address - Street 1:1600 S IMPERIAL AVE STE 7
Mailing Address - Street 2:
Mailing Address - City:EL CENTRO
Mailing Address - State:CA
Mailing Address - Zip Code:92243-4242
Mailing Address - Country:US
Mailing Address - Phone:760-312-9817
Mailing Address - Fax:760-312-9824
Practice Address - Street 1:1600 S IMPERIAL AVE STE 7
Practice Address - Street 2:
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-4242
Practice Address - Country:US
Practice Address - Phone:760-312-9817
Practice Address - Fax:760-312-9824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-06
Last Update Date:2013-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility