Provider Demographics
NPI:1144775263
Name:PRODIGY HEALTHCARE INC.
Entity Type:Organization
Organization Name:PRODIGY HEALTHCARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAGDIP
Authorized Official - Middle Name:
Authorized Official - Last Name:DHANDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-892-9452
Mailing Address - Street 1:PO BOX 820
Mailing Address - Street 2:
Mailing Address - City:FOWLER
Mailing Address - State:CA
Mailing Address - Zip Code:93625-0820
Mailing Address - Country:US
Mailing Address - Phone:559-892-9452
Mailing Address - Fax:
Practice Address - Street 1:2801 W ADAMS AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93706-9601
Practice Address - Country:US
Practice Address - Phone:559-892-9452
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-18
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health