Healthcare Provider Details

I. General information

NPI: 1184991291
Provider Name (Legal Business Name): WESTCARE CALIFORNIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2011
Last Update Date: 11/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2772 MARTIN L KING JR BLVD
FRESNO CA
93706-5345
US

IV. Provider business mailing address

2772 MARTIN L KING JR BLVD
FRESNO CA
93706-5345
US

V. Phone/Fax

Practice location:
  • Phone: 559-265-4800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

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