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General NPI Number Information
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NPI Number | 1700412368
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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 | 03/16/2020
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Last Update Date | 12/04/2024
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Provider Practice Location Address
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Address Line | 4001 HWY 104
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City | IONE
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State | CA
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Zip | 95640
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Country | US
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Telephone | 209-274-4911
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Fax | 209-274-6039
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Provider Business Mailing Address
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Address Line | PO BOX 409099
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City | IONE
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State | CA
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Zip | 95640
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Country | US
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Telephone | 209-274-4911
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Fax | 209-274-5039
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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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