Provider Demographics
NPI:1922308642
Name:CORRECTIONS AND REHABILITATION-HEADQUARTERS
Entity type:Organization
Organization Name:CORRECTIONS AND REHABILITATION-HEADQUARTERS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:STAFF SERVICES MANAGER I
Authorized Official - Prefix:
Authorized Official - First Name:PIERRE
Authorized Official - Middle Name:CAESARE SAUCIER
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-780-6997
Mailing Address - Street 1:1 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:SAN QUENTIN
Mailing Address - State:CA
Mailing Address - Zip Code:94964
Mailing Address - Country:US
Mailing Address - Phone:415-454-1460
Mailing Address - Fax:415-419-4234
Practice Address - Street 1:1 MAIN STREET
Practice Address - Street 2:
Practice Address - City:SAN QUENTIN
Practice Address - State:CA
Practice Address - Zip Code:94964
Practice Address - Country:US
Practice Address - Phone:415-454-1460
Practice Address - Fax:415-419-4234
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CORRECTIONS AND REHABILITATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-10-28
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA173783336I0012X
333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336I0012XSuppliersPharmacyInstitutional Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5639212OtherNCPDP PROVIDER IDENTIFICATION NUMBER