Healthcare Provider Details

I. General information

NPI: 1962874172
Provider Name (Legal Business Name): NAPA STATE HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2015
Last Update Date: 10/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 NAPA VALLEJO HWY
NAPA CA
94558-6234
US

IV. Provider business mailing address

1684 PEAR TREE LN
NAPA CA
94558-6487
US

V. Phone/Fax

Practice location:
  • Phone: 707-815-9690
  • Fax:
Mailing address:
  • Phone: 707-815-9690
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number36253
License Number StateCA

VIII. Authorized Official

Name: MR. JOHN BOLING
Title or Position: PHARMACIST I
Credential: RPH
Phone: 707-253-5264