# IMPERIAL COUNTY LOCAL HEALTH AUTHORITY

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Community Health Plan of Imperial Valley
- **Organization subpart:** No

## Provider details

- **NPI number:** 1760254973
- **Authorized official:** MARK SOUTHWORTH (CFO)
- **Authorized official phone:** (760) 970-5034

## Contact information

- **Practice address:** 512 W ATEN RD, IMPERIAL, CA 92251-9718
- **Practice address phone:** (760) 970-5034
- **Mailing address:** 512 W ATEN RD, IMPERIAL, CA 92251-9718

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 302R00000X | Health Maintenance Organization | — | NULL | Yes |

## Other

- **Enumeration date:** 10/23/2023
- **Last updated:** 10/23/2023