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1104758333 NPI number — CALIFORNIA COMMUNITY SERVICES AND REHABILITATION

NPI Number: 1104758333
Health Care Provider/Practitioner: CALIFORNIA COMMUNITY SERVICES AND REHABILITATION

Information about “1104758333” NPI (CALIFORNIA COMMUNITY SERVICES AND REHABILITATION) exists in 1104758333 in HTML format HTML  |  1104758333 in plain Text format TXT  |  1104758333 in PDF (Portable Document Format) PDF  |  1104758333 in an XML format XML  formats.

NPI Number : 1104758333 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1104758333",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "CALIFORNIA COMMUNITY SERVICES AND REHABILITATION",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "PO BOX 41",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "VACAVILLE",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "95696-0041",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "707-549-8747",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "307 W STROTHER AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "FRESNO",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "93706-2936",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "707-549-8747",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "06/02/2026",
    "LastUpdateDate": "06/02/2026",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "ANDERSON",
    "AuthorizedOfficialFirstName": "CARTER",
    "AuthorizedOfficialMiddleName": "LEE",
    "AuthorizedOfficialTitle": "FOUNDER/PRESIDENT",
    "AuthorizedOfficialNamePrefix": "MR.",
    "AuthorizedOfficialNameSuffix": "JR.",
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "707-592-6281",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "251S00000X",
        "TaxonomyName": "Community/Behavioral Health Agency",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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