Basic Information
| Provider Information | |||||||||
| NPI: | 1578703815 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WESTCARE CALIFORNIA, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4944 E CLINTON WAY STE 105 | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937271527 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5592514800 | ||||||||
| FaxNumber: | 5594537827 | ||||||||
| Practice Location | |||||||||
| Address1: | 4944 E CLINTON WAY STE 101 | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937271527 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5592514800 | ||||||||
| FaxNumber: | 5594536969 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/26/2009 | ||||||||
| LastUpdateDate: | 02/26/2009 | ||||||||
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| AuthorizedOfficialLastName: | PIMENTEL | ||||||||
| AuthorizedOfficialFirstName: | LYNN | ||||||||
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| AuthorizedOfficialTitleorPosition: | DEPUTY ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 5592514800 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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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 |
ID Information
| ID | Type | State | Issuer | Description | 1026 | 01 | CA | CALIFORNIA DRUG MEDI-CAL | OTHER |