NPIMap

Organization Active NPI

Prodigy Healthcare, Inc.

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Fowler, CA
National Provider Identifier
1245537612
Registry record updated Jul 16, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X
Legal business name
PRODIGY HEALTHCARE, INC.
Practice address
975 East Adams Avenue
(Rooms 1-5,Offices 1-3)
Fowler, CA 93625
Phone
(888) 885-5580
Fax
(888) 885-5580
NPI assigned
Feb 22, 2011
Last updated
Jul 16, 2013By the provider in NPPES
Organization subpart
Yes
Parent organization
PRODIGY HEALTHCARE, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 16, 2013

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

Authorized official

Name
Mr. Jagdip DhandaNPI 1194960005
Title
Ceo
Phone
(559) 892-9452

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X NU Primary

Addresses

Primary practice location

975 East Adams Avenue
(Rooms 1-5,Offices 1-3)
Fowler, CA 93625

Mailing address

PO Box 820
Fowler, CA 93625-0820
Phone (888) 885-5580

Other identifiers 1

IdentifierTypeStateIssuer
PENDINGOtherCADRUG MEDI-CAL

National Provider Directory

National Provider Directory
Tax ID family
Prodigy Healthcare Inc18 organizations share this tax ID, including this one
Part of
Prodigy Healthcare Inc

Other organizations with this tax ID 17

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

View all 17

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1298332800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1373932800000",
    "number": "1245537612",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 820",
            "city": "FOWLER",
            "state": "CA",
            "postal_code": "936250820",
            "telephone_number": "888-885-5580",
            "fax_number": "888-885-5580"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "975 EAST ADAMS AVENUE",
            "address_2": "(ROOMS 1-5,OFFICES 1-3)",
            "city": "FOWLER",
            "state": "CA",
            "postal_code": "93625",
            "telephone_number": "888-885-5580",
            "fax_number": "888-885-5580"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRODIGY HEALTHCARE, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PRODIGY HEALTHCARE, INC.",
        "enumeration_date": "2011-02-22",
        "last_updated": "2013-07-16",
        "status": "A",
        "authorized_official_last_name": "DHANDA",
        "authorized_official_first_name": "JAGDIP",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "559-892-9452",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DRUG MEDI-CAL",
            "identifier": "PENDING",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fowler, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.