Healthcare Provider Details

I. General information

NPI: 1053681387
Provider Name (Legal Business Name): CALIFORNIA DEPARTMENT OF CORRECTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2012
Last Update Date: 01/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2180 ELLERY AVE
CLOVIS CA
93611-0652
US

IV. Provider business mailing address

2180 ELLERY AVE
CLOVIS CA
93611-0652
US

V. Phone/Fax

Practice location:
  • Phone: 559-297-6748
  • Fax:
Mailing address:
  • Phone: 559-297-6748
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW CATE
Title or Position: SECRETARY
Credential: J.D.
Phone: 877-793-4473