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General NPI Number Information
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NPI Number | 1396169405
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Entity Type | Organization
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Legal Business Name | CORRECTIONS AND REHABILITATION-HEADQUARTERS
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Dates
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Enumeration Date | 02/10/2014
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Last Update Date | 12/04/2024
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Provider Practice Location Address
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Address Line | 8280 LONG LEAF DRIVE D2-406
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City | ELK GROVE
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State | CA
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Zip | 95758
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Country | US
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Telephone | 916-691-5749
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Fax |
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Provider Business Mailing Address
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Address Line | 8280 LONG LEAF DRIVE D3-731
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City | ELK GROVE
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State | CA
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Zip | 95758
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Country | US
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Telephone | 916-691-9913
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Fax | 916-691-3442
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Authorized Official
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Title or Position | STAFF SERVICES MANAGER I
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Name | PIERRE CAESARE SAUCIER JAMES
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Credential |
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Telephone | 510-780-6997
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2400X
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Taxonomy Name | Prison Health Clinic/Center
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License Number |
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License Number State |
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