Prodigy Healthcare, Inc.
Organization Active NPI Substance Use Disorder Rehabilitation Clinic/Center · Fowler, CA
NPI 1497051627 · NPPES record last updated Nov 27, 2013
Key facts
- NPI
- 1497051627
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X
- Legal business name
- PRODIGY HEALTHCARE, INC.
- Practice address
- 311 E Merced St
(Rooms 1-7 , Conference Room )
Fowler, CA 93625-2316 - Phone
- (888) 885-5580
- Fax
- (888) 885-5580
- NPI assigned
- Feb 5, 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
311 E Merced St
Rm 17
Fowler, CA 93625
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Substance Use Disorder Rehabilitation Clinic/Center | 261QR0405X | CA | Yes |
Addresses
Primary practice location
311 E Merced St
(Rooms 1-7 , Conference Room )
Fowler, CA 93625-2316
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 Fowler, CA
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- Moncerrat Galilea Pimentel
- Jacqueline Ninfa Plaza
- Prodigy Healthcare Non Profit
- Prodigy Healthcare, Inc.
- Prodigy Healthcare, Inc.
- Prodigy Healthcare, Inc.
- Harjas Singh Rakhra
- Jasmeet Kaur Rakhra
- Annabel Ramirez
All providers in Fowler, 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 Nov 27, 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.