Provider Demographics
NPI:1912662883
Name:IMPERIAL MANOR SKILLED NURSING INC
Entity Type:Organization
Organization Name:IMPERIAL MANOR SKILLED NURSING INC
Other - Org Name:IMPERIAL VALLEY RURAL HEALTH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ESMERALDA
Authorized Official - Middle Name:
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:442-283-3494
Mailing Address - Street 1:290 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BRAWLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92227-2351
Mailing Address - Country:US
Mailing Address - Phone:760-550-1510
Mailing Address - Fax:877-550-2018
Practice Address - Street 1:290 MAIN ST
Practice Address - Street 2:
Practice Address - City:BRAWLEY
Practice Address - State:CA
Practice Address - Zip Code:92227-2351
Practice Address - Country:US
Practice Address - Phone:442-456-6346
Practice Address - Fax:877-550-2018
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:IMPERIAL MANOR SKILLED NURSING INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-11-04
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health