Basic Information
| Provider Information | |||||||||
| NPI: | 1124598305 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WESTCARE CALIFORNIA, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1900 N GATEWAY BLVD | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937271622 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5592514800 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3636 N. FIRST STREET | ||||||||
| Address2: | SUITE 123 | ||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937266818 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5592514800 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/29/2018 | ||||||||
| LastUpdateDate: | 11/29/2018 | ||||||||
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| AuthorizedOfficialLastName: | ALLEN | ||||||||
| AuthorizedOfficialFirstName: | MICHELLE | ||||||||
| AuthorizedOfficialMiddleName: | LEE | ||||||||
| AuthorizedOfficialTitleorPosition: | QUALITY ASSURANCE ASSISSTANT | ||||||||
| AuthorizedOfficialTelephone: | 5592514800 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0801X | Y | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |
No ID Information.