Provider Demographics
NPI:1023526084
Name:TRI-STATE COMMUNITY HEALTHCARE CENTER
Entity type:Organization
Organization Name:TRI-STATE COMMUNITY HEALTHCARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGED CARE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CRYSTALE
Authorized Official - Middle Name:
Authorized Official - Last Name:MINEROS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-297-0884
Mailing Address - Street 1:540 N SAN JACINTO ST STE P
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92543-3154
Mailing Address - Country:US
Mailing Address - Phone:951-929-4000
Mailing Address - Fax:
Practice Address - Street 1:540 N SAN JACINTO ST STE P
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543-3154
Practice Address - Country:US
Practice Address - Phone:951-929-4000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRI-STATE COMMUNITY HEALTHCARE CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-01-11
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)