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General NPI Number Information
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NPI Number | 1376689042
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Entity Type | Organization
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Legal Business Name | CORNELL CORRECTIONS OF CALIFORNIA, INC.
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Dates
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Enumeration Date | 01/30/2007
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Last Update Date | 06/29/2012
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Provider Practice Location Address
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Address Line | 700 FOURMILE PKWY
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City | CANON CITY
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State | CO
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Zip | 81212-9114
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Country | US
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Telephone | 719-276-7500
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Fax | 719-276-6961
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Provider Business Mailing Address
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Address Line | 700 FOURMILE PKWY
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City | CANON CITY
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State | CO
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Zip | 81212-9114
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Country | US
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Telephone | 719-276-7500
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Fax | 719-276-6961
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Authorized Official
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Title or Position | FACILITY DIRECTOR
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Name | MR. JOSEPH WILNER
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Credential |
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Telephone | 719-276-7500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 323P00000X
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Taxonomy Name | Psychiatric Residential Treatment Facility
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License Number | 1526789
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number | 1526789
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License Number State | CO
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