Provider Demographics
NPI:1053681387
Name:CALIFORNIA DEPARTMENT OF CORRECTIONS
Entity type:Organization
Organization Name:CALIFORNIA DEPARTMENT OF CORRECTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:CATE
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:877-793-4473
Mailing Address - Street 1:2180 ELLERY AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93611-0652
Mailing Address - Country:US
Mailing Address - Phone:559-297-6748
Mailing Address - Fax:
Practice Address - Street 1:2180 ELLERY AVE
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93611-0652
Practice Address - Country:US
Practice Address - Phone:559-297-6748
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-04
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility