NPIMap

Organization Active NPI

Department of State Hospitals

Doing business as Coalinga State Hospital

  • Psychiatric Hospital
  • Coalinga, CA
National Provider Identifier
1124078704
Registry record updated Oct 19, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric HospitalTaxonomy code 283Q00000X
Legal business name
DEPARTMENT OF STATE HOSPITALS
Doing business as
Coalinga State Hospital
Practice address
24511 W Jayne Ave
Coalinga, CA 93210-9503
Phone
(559) 935-4300
Fax
(559) 935-7118
NPI assigned
May 12, 2006
Last updated
Oct 19, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 19, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
George Maynard
Title
Administrative Deputy Director
Phone
(916) 651-3238

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X
Psychiatric Hospital 283Q00000X Primary
Mental Illness Intermediate Care Facility 310500000X
Pharmacy 333600000X
Long Term Care Pharmacy 3336L0003X HPE47182 CA

Addresses

Primary practice location

24511 W Jayne Ave
Coalinga, CA 93210-9503

Mailing address

1215 O St # Ms -3
Sacramento, CA 95814-5804
Phone (916) 651-8906

Other names 1

  • COALINGA STATE HOSPITAL Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20081031000305 CA Part B Supplier - Clinic/Group Practice 9638174238 Receives reassigned benefits from 751 practitioners
4 other NPIs on this enrollment
Practice locations: Atascadero, CA; Coalinga, CA; Napa, CA; Norwalk, CA; Patton, CA

Other NPIs with the same Medicare PAC ID 4

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 4

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
DPT of State Hospitals5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All facility ownership & control disclosures 4

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Patton State HospitalPatton, CA, CCN 05124E Hospital Operational/Managerial Control Oct 1, 1982
Napa State HospitalNapa, CA, CCN 054122 Hospital Operational/Managerial Control Jul 1, 2011
Metropolitan State HospitalNorwalk, CA, CCN 054133 Hospital Operational/Managerial Control (100%) Jul 1, 2011
Atascadero State HospitalAtascadero, CA, CCN 05125E Hospital Operational/Managerial Control Oct 1, 1982

Owned or controlled facilities with NPI records 4

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Subparts reporting this organization as parent 4

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 799

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 799

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1147392000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1634601600000",
    "number": "1124078704",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1215 O ST # MS -3",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958145804",
            "telephone_number": "916-651-8906",
            "fax_number": "916-651-8908"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24511 W JAYNE AVE",
            "city": "COALINGA",
            "state": "CA",
            "postal_code": "932109503",
            "telephone_number": "559-935-4300",
            "fax_number": "559-935-7118"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEPARTMENT OF STATE HOSPITALS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-12",
        "last_updated": "2021-10-19",
        "certification_date": "2021-10-19",
        "status": "A",
        "authorized_official_last_name": "MAYNARD",
        "authorized_official_first_name": "GEORGE",
        "authorized_official_title_or_position": "ADMINISTRATIVE DEPUTY DIRECTOR",
        "authorized_official_telephone_number": "916-651-3238"
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "283Q00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Hospital",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "310500000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Mental Illness",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "CA",
            "license": "HPE47182",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "COALINGA STATE HOSPITAL",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Coalinga, CA

Sources for this page

Verify at the official NPI Registry.