NPIMap

Organization Active NPI

Prodigy Healthcare, Inc.

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Fowler, CA
National Provider Identifier
1972800340
Registry record updated Jun 28, 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
701 E Walter Ave
(Rooms C10 and C11)
Fowler, CA 93625-9792
Phone
(888) 885-5580
Fax
(888) 885-5580
NPI assigned
Feb 22, 2011
Organization subpart
Yes
Parent organization
PRODIGY HEALTHCARE, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 28, 2013

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

Authorized official

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

Specialties & licenses 1

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

Addresses

Primary practice location

701 E Walter Ave
(Rooms C10 and C11)
Fowler, CA 93625-9792

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

Locations

701 E Walter Ave
Rm C10
Fowler, CA 93625

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": "1372377600000",
    "number": "1972800340",
    "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": "701 E WALTER AVE",
            "address_2": "(ROOMS C10 AND C11)",
            "city": "FOWLER",
            "state": "CA",
            "postal_code": "936259792",
            "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": "2013-06-28",
        "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": null,
            "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 Jun 28, 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.