Provider Demographics
NPI: | 1700074234 |
---|---|
Name: | IMPERIAL COUNTY BEHAVIORAL HEALTH SERVICES |
Entity Type: | Organization |
Organization Name: | IMPERIAL COUNTY BEHAVIORAL HEALTH SERVICES |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | DIRECTOR |
Authorized Official - Prefix: | |
Authorized Official - First Name: | MICHAEL |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | HORN |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 760-482-4000 |
Mailing Address - Street 1: | 600 S WILSON ST RM 29A |
Mailing Address - Street 2: | |
Mailing Address - City: | EL CENTRO |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 92243-3124 |
Mailing Address - Country: | US |
Mailing Address - Phone: | |
Mailing Address - Fax: | |
Practice Address - Street 1: | 600 S WILSON ST RM 29A |
Practice Address - Street 2: | |
Practice Address - City: | EL CENTRO |
Practice Address - State: | CA |
Practice Address - Zip Code: | 92243-3124 |
Practice Address - Country: | US |
Practice Address - Phone: | 760-482-4000 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | IMPERIAL COUNTY BEHAVIORAL HEALTH SERVICES |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2007-10-10 |
Last Update Date: | 2008-01-22 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QR0405X | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Substance Use Disorder |