Basic Information
| Provider Information | |||||||||
| NPI: | 1114395134 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WESTCARE CALIFORNIA, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1505 N CHESTNUT AVE | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937034504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5592514800 | ||||||||
| FaxNumber: | 5594537827 | ||||||||
| Practice Location | |||||||||
| Address1: | 1045 BETHEL AVE | ||||||||
| Address2: | |||||||||
| City: | SANGER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 936572985 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5592514800 | ||||||||
| FaxNumber: | 5594537827 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/08/2015 | ||||||||
| LastUpdateDate: | 09/08/2015 | ||||||||
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| AuthorizedOfficialLastName: | PISTALU | ||||||||
| AuthorizedOfficialFirstName: | MARYELLEN | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR CONTRACT COMPLIANCE | ||||||||
| AuthorizedOfficialTelephone: | 5592514800 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MS | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0405X | Y | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Substance Use Disorder |
No ID Information.