=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457906745
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CORRECTIONS AND REHABILITATION-HEADQUARTERS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/05/2019
-----------------------------------------------------
Last Update Date | 12/04/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5TH AND WESTERN AVE, MODULE M, ROOM #104
-----------------------------------------------------
City | NORCO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92860
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 951-737-2683
-----------------------------------------------------
Fax | 951-273-2396
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5TH AND WESTERN AVE, MODULE M, ROOM #104
-----------------------------------------------------
City | NORCO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92860
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 951-737-2683
-----------------------------------------------------
Fax | 951-273-2396
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | STAFF SERVICES MANAGER I
-----------------------------------------------------
Name | PIERRE CAESARE SAUCIER JAMES
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 510-780-6997
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336I0012X
-----------------------------------------------------
Taxonomy Name | Institutional Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------