Provider Demographics
NPI:1083381776
Name:FOUR CORNERS HEALTH, I NC.
Entity Type:Organization
Organization Name:FOUR CORNERS HEALTH, I NC.
Other - Org Name:FOUR CORNERS HEALTH
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CASHMIR
Authorized Official - Middle Name:
Authorized Official - Last Name:LUKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-933-2264
Mailing Address - Street 1:PO BOX 690311
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95269-0311
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:204 N FLORAL ST STE B
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-4957
Practice Address - Country:US
Practice Address - Phone:800-666-5323
Practice Address - Fax:844-686-2020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-30
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251G00000XAgenciesHospice Care, Community Based
No251S00000XAgenciesCommunity/Behavioral Health
No253Z00000XAgenciesIn Home Supportive Care
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QP2400XAmbulatory Health Care FacilitiesClinic/CenterPrison Health
No332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies
No385HR2050XRespite Care FacilityRespite CareRespite Care Camp
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA63-21082OtherHOME HEALTH AGENCY