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General NPI Number Information
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NPI Number | 1548607393
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Entity Type | Organization
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Legal Business Name | CALIFORNIA CORRECTIONAL HEALTH CARE SERVICES
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Dates
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Enumeration Date | 06/03/2013
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Last Update Date | 06/03/2013
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Provider Practice Location Address
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Address Line | 8280 LONG LEAF DRIVE BLDG D-172
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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 | 916-691-6150
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Fax |
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Provider Business Mailing Address
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Address Line | 8280 LONG LEAF DRIVE, BLDG D-172
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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 | 916-691-6150
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Fax |
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Authorized Official
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Title or Position | CHIEF OF MENTAL HEALTH
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Name | MR. JOHN REKART
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Credential | MD
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Telephone | 916-691-6150
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 276400000X
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Taxonomy Name | Substance Use Disorder Rehabilitation Hospital Unit
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License Number | A26603
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License Number State | CA
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