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General NPI Number Information
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NPI Number | 1124078704
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Entity Type | Organization
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Legal Business Name | DEPARTMENT OF STATE HOSPITALS
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Dates
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Enumeration Date | 05/12/2006
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Last Update Date | 10/19/2021
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Provider Practice Location Address
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Address Line | 24511 W JAYNE AVE
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City | COALINGA
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State | CA
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Zip | 93210-9503
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Country | US
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Telephone | 559-935-4300
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Fax | 559-935-7118
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Provider Business Mailing Address
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Address Line | 1215 O ST # MS -3
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City | SACRAMENTO
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State | CA
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Zip | 95814-5804
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Country | US
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Telephone | 916-651-8906
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Fax | 916-651-8908
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Authorized Official
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Title or Position | ADMINISTRATIVE DEPUTY DIRECTOR
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Name | GEORGE MAYNARD
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Credential |
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Telephone | 916-651-3238
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 310500000X
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Taxonomy Name | Mental Illness Intermediate Care Facility
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number | HPE47182
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License Number State | CA
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Taxonomy #5
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Taxonomy Code | 283Q00000X
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Taxonomy Name | Psychiatric Hospital
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License Number |
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License Number State |
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