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General NPI Number Information
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NPI Number | 1699231738
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Entity Type | Organization
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Legal Business Name | CALIFORNIA SERVICE DOG ACADEMY
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Dates
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Enumeration Date | 02/13/2019
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Last Update Date | 02/13/2019
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Provider Practice Location Address
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Address Line | 18701 LORT DR
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City | VISALIA
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State | CA
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Zip | 93292-9652
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Country | US
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Telephone | 866-382-9917
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Fax |
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Provider Business Mailing Address
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Address Line | 18701 LORT DR
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City | VISALIA
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State | CA
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Zip | 93292-9652
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MATTHEW CORSO
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Credential |
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Telephone | 866-382-9917
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251V00000X
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Taxonomy Name | Voluntary or Charitable Agency
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License Number |
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License Number State |
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