Healthcare Provider Details

I. General information

NPI: 1255460176
Provider Name (Legal Business Name): CORCORAN DISTRICT HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 02/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 HANNA AVE #3
CORCORAN CA
93212-2314
US

IV. Provider business mailing address

1310 HANNA AVE #3
CORCORAN CA
93212-2314
US

V. Phone/Fax

Practice location:
  • Phone: 559-992-5051
  • Fax: 559-992-3972
Mailing address:
  • Phone: 559-992-5051
  • Fax: 559-992-3972

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number040000087
License Number StateCA

VIII. Authorized Official

Name: DEBBIE BACH
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 559-992-5051