Healthcare Provider Details

I. General information

NPI: 1699231738
Provider Name (Legal Business Name): CALIFORNIA SERVICE DOG ACADEMY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2019
Last Update Date: 02/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18701 LORT DR
VISALIA CA
93292-9652
US

IV. Provider business mailing address

18701 LORT DR
VISALIA CA
93292-9652
US

V. Phone/Fax

Practice location:
  • Phone: 866-382-9917
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW CORSO
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 866-382-9917