Organization
BORREGO COMMUNITY HEALTH FOUNDATION
Active
Organization
BORREGO COMMUNITY HEALTH FOUNDATION
Active
Parent organization
BORREGO COMMUNITY HEALTH FOUNDATION
Other names
LAKE ELSINORE CLINICA MEDICA FAMILIAR
Organization subpart
Yes
Provider details
NPI number
Legal business name
BORREGO COMMUNITY HEALTH FOUNDATION
Authorized official
MIKIA BRAYTON WALLIS (CEO)
(760) 767-6641
Entity
Organization
Contact information
Practice address
31739 RIVERSIDE DR STE A1, LAKE ELSINORE, CA 92530-7818
(619) 873-3538
Mailing address
PO BOX 2369, BORREGO SPRINGS, CA 92004-2369
(619) 873-3538
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Enumeration date
04/30/2019
Last updated
04/30/2019
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