Healthcare Provider Details

I. General information

NPI: 1053690982
Provider Name (Legal Business Name): CALIFORNIA DEPARTMENT OF CORRECTIONS AND REHABILITATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2011
Last Update Date: 08/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 CALIFORNIA DR
VACAVILLE CA
95696
US

IV. Provider business mailing address

1600 CALIFORNIA DR.
VACAVILLE CA
95696
US

V. Phone/Fax

Practice location:
  • Phone: 707-448-6841
  • Fax:
Mailing address:
  • Phone: 707-448-6841
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberA91928
License Number StateCA

VIII. Authorized Official

Name: DR. JOSEPH BICK
Title or Position: CHIEF MEDICAL EXECUTIVE
Credential: MD
Phone: 707-449-6576