1649413956 NPI number — WESTCARE CALIFORNIA, INC. (CODAC)

Table of content: ERLAND DALE KIDDIE JR. SOCIAL WORKER (NPI 1669657425)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649413956 NPI number — WESTCARE CALIFORNIA, INC. (CODAC)

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WESTCARE CALIFORNIA, INC. (CODAC)
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1649413956
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/16/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4944 E CLINTON WAY
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
FRESNO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93727-1527
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
559-251-4800
Provider Business Mailing Address Fax Number:
559-453-6969

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4411 E KINGS CANYON RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRESNO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93702-3604
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-251-4800
Provider Business Practice Location Address Fax Number:
559-453-6969
Provider Enumeration Date:
04/16/2009

Additional Information

Authorized Official

Authorized Official Last Name:
PIMENTEL
Authorized Official First Name:
LYNN
Authorized Official Middle Name:
Authorized Official Title or Position:
DEPUTY ADMINISTRATOR
Authorized Official Telephone Number:
559-251-4800

Provider Taxonomy Codes

  • Taxonomy code: 261QM0850X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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