Department of State Hospitals
Organization Active NPI Psychiatric Hospital · Coalinga, CA
NPI 1124078704 · NPPES record last updated Oct 19, 2021
Key facts
- NPI
- 1124078704
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Psychiatric Hospital 283Q00000X
- Legal business name
- DEPARTMENT OF STATE HOSPITALS
- Practice address
- 24511 W Jayne Ave
Coalinga, CA 93210-9503 - Phone
- (559) 935-4300
- Fax
- (559) 935-7118
- NPI assigned
- May 12, 2006
- Organization subpart
- No
Authorized official
- Name
- George Maynard
- Title
- Administrative Deputy Director
- Phone
- (916) 651-3238
Owned or controlled facilities with NPI records 4
Other NPIs on the same Medicare enrollment 4
Other NPIs with the same Medicare PAC ID 4
Subparts reporting this organization as parent 4
Corporate family (same tax ID) 4
Practitioners 799
-
Arin Abnoosian, M.D.
-
Mary Gamil Absood, M.D.
-
Elizabeth Ngoc Ha Agbuya, O.D.
-
Waseem Ahmad, MD
-
Ali Akhavan, MD
-
Mona Alipour, M.D
-
Jaydina D Amaker, PSY.D.
-
Sammy Omar Amasha, RPT
-
Sohrab Amiri, M.D.
-
Mirwais Amoni, M.D.
-
Ronalyn Macayan Amor, FNP
-
Grace Zapata Ang, M.D.
-
Rahat Aulakh, MD
-
Raghunath Bansal, M.D.
-
Joanne Margaret Barba, PSY.D.
-
Ali-Reza Barmaki, M.D.
-
Reda Bendaoud, M.D.
-
Austin William Blum, MD, JD
-
David Bohannon, D.O.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
All facility ownership & control disclosures 4
| Facility | Type | Role | Since |
|---|---|---|---|
| Patton State Hospital |
Hospital | Operational/Managerial Control | Oct 1, 1982 |
| Napa State Hospital |
Hospital | Operational/Managerial Control | Jul 1, 2011 |
| Metropolitan State Hospital |
Hospital | Operational/Managerial Control (100%) | Jul 1, 2011 |
| Atascadero State Hospital |
Hospital | Operational/Managerial Control | Oct 1, 1982 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 |
National Provider Directory
- Tax ID family
- Dept of State Hosp
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Acute Care Hospital | 282N00000X | |||
| Psychiatric Hospital | 283Q00000X | Yes | ||
| 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 identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2117241 | Other | PK |
Other names
- COALINGA STATE HOSPITAL
Other providers in Coalinga, CA
- Jeffrey Jay Davis
- Richard C Davis Jr.
- Frieda Dehnavifar
- Department of State Hospital Coalinga
- Department of State Hospital Coalinga
- Tracy Dern
- Deleon Devaughn
- David Dinishak
- Lamberto Samodio Domingo
- Kwame A Donkor
All providers in Coalinga, CA · Psychiatric Hospital in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 19, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.