Healthcare Provider Details

I. General information

NPI: 1457606972
Provider Name (Legal Business Name): WESTCARE CALIFORNIA INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2012
Last Update Date: 10/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

808 S 10TH ST
FRESNO CA
93702-3506
US

IV. Provider business mailing address

4928 E CLINTON WAY STE 101
FRESNO CA
93727-1526
US

V. Phone/Fax

Practice location:
  • Phone: 559-443-4850
  • Fax:
Mailing address:
  • Phone: 559-255-8838
  • Fax: 559-452-8107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LYNN PIMENTEL
Title or Position: DEPUTY ADMINSITRATOR
Credential:
Phone: 559-265-4800