Organization Name: | PRODIGY HEALTHCARE, INC. |
NPI Number: | 1972800340 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JAGDIP DHANDA (CEO) |
Mailing Address: | 701 E Walter Ave (rooms C10 And C11) Fowler |
State: | CA US |
Postal Code: | 936259792 |
Phone Number: | 8888855580 |
Fax Number: | 8888855580 |
NPI Enumeration Date: | 02/22/2011 |
NPI Last Update Date: | 06/28/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QR0405X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Rehabilitation, Substance Use Disorder |
Taxonomy Definition: |