Prodigy Healthcare, Inc.
Organization Active NPI Substance Use Disorder Rehabilitation Clinic/Center · Firebaugh, CA
NPI 1134425200 · NPPES record last updated Jun 28, 2013
Key facts
- NPI
- 1134425200
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X
- Legal business name
- PRODIGY HEALTHCARE, INC.
- Practice address
- 1666 Saipan Ave
(Rooms 1-8)
Firebaugh, CA 93622-2438 - Phone
- (888) 885-5580
- Fax
- (888) 885-5580
- NPI assigned
- Feb 7, 2011
- Organization subpart
- Yes
- Parent organization (as reported)
- PRODIGY HEALTHCARE, INC.
Authorized official
- Name
- Mr. Jagdip Dhanda
- Title
- Ceo
- Phone
- (559) 892-9452
Corporate family (same tax ID) 17
National Provider Directory
- Tax ID family
- Prodigy Healthcare Inc
- Part of
- Prodigy Healthcare Inc
Locations
1666 Saipan Ave
Rm 18
Firebaugh, CA 93622
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Substance Use Disorder Rehabilitation Clinic/Center | 261QR0405X | CA | Yes |
Addresses
Primary practice location
1666 Saipan Ave
(Rooms 1-8)
Firebaugh, CA 93622-2438
Mailing address
PO Box 820
Fowler, CA 93625-0820
Phone (888) 885-5580
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PENDING | Other | CA | MEDI-CAL |
Other providers in Firebaugh, CA
- Amandeep Kaur Kahal
- Evelyn Aguilera Kramer
- Ronald Leonard Louie
- Phys Med Inc.
- Poladian & Mamigonian
- Prodigy Healthcare, Inc.
- Prodigy Healthcare, Inc.
- Prodigy Healthcare, Inc.
- Jaspreet K Riar
- Gabriela Rodas
All providers in Firebaugh, CA · Substance Use Disorder Rehabilitation Clinic/Center in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 28, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.