Healthcare Provider Details

I. General information

NPI: 1932735420
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

7707 SOUTH AUSTIN ROAD ROOM 123
STOCKTON CA
95215
US

IV. Provider business mailing address

7707 SOUTH AUSTIN ROAD ROOM 123
STOCKTON CA
95215
US

V. Phone/Fax

Practice location:
  • Phone: 209-467-2500
  • Fax: 209-467-1595
Mailing address:
  • Phone: 209-467-2500
  • Fax: 209-467-1595

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