Healthcare Provider Details

I. General information

NPI: 1023644580
Provider Name (Legal Business Name): CORRECTIONS AND REHABILITATION-HEADQUARTERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2020
Last Update Date: 12/04/2024
Certification Date: 12/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HIGHWAY 1
SAN LUIS OBISPO CA
93409
US

IV. Provider business mailing address

PO BOX 8101
SAN LUIS OBISPO CA
93409-8101
US

V. Phone/Fax

Practice location:
  • Phone: 805-547-7900
  • Fax: 805-547-7326
Mailing address:
  • Phone: 805-547-7900
  • Fax: 805-547-7326

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

Name: PIERRE CAESARE SAUCIER JAMES
Title or Position: STAFF SERVICES MANAGER I
Credential:
Phone: 510-780-6997