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General NPI Number Information
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NPI Number | 1679108476
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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 | 03/12/2020
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Last Update Date | 12/04/2024
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Provider Practice Location Address
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Address Line | 2302 BROWN ROAD
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City | IMPERIAL
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State | CA
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Zip | 92251
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Country | US
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Telephone | 760-337-7900
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Fax | 760-482-3006
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Provider Business Mailing Address
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Address Line | P.O. BOX 731
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City | IMPERIAL
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State | CA
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Zip | 92251-0731
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Country | US
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Telephone | 760-337-7900
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Fax | 760-482-3006
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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 | 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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