Provider Demographics
NPI:1114395134
Name:WESTCARE CALIFORNIA, INC.
Entity Type:Organization
Organization Name:WESTCARE CALIFORNIA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR CONTRACT COMPLIANCE
Authorized Official - Prefix:
Authorized Official - First Name:MARYELLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:PISTALU
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:559-251-4800
Mailing Address - Street 1:1505 N CHESTNUT AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93703-4504
Mailing Address - Country:US
Mailing Address - Phone:559-251-4800
Mailing Address - Fax:559-453-7827
Practice Address - Street 1:1045 BETHEL AVE
Practice Address - Street 2:
Practice Address - City:SANGER
Practice Address - State:CA
Practice Address - Zip Code:93657-2985
Practice Address - Country:US
Practice Address - Phone:559-251-4800
Practice Address - Fax:559-453-7827
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-08
Last Update Date:2015-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder