Healthcare Provider Details

I. General information

NPI: 1649658824
Provider Name (Legal Business Name): WESTCARE CALIFORNIA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2015
Last Update Date: 01/04/2024
Certification Date: 01/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 N GATEWAY BLVD
FRESNO CA
93727-1622
US

IV. Provider business mailing address

1900 N GATEWAY BLVD
FRESNO CA
93727-1622
US

V. Phone/Fax

Practice location:
  • Phone: 559-251-4800
  • Fax: 559-453-7827
Mailing address:
  • Phone: 559-251-4800
  • Fax: 559-453-7827

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License NumberG057966
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MICHELLE LEE ALLEN
Title or Position: DIRECTOR OF CONTRACT COMPLIANCE
Credential:
Phone: 559-251-4800