Provider Demographics
NPI:1437496858
Name:CALIPATRIA STATE PRISON
Entity Type:Organization
Organization Name:CALIPATRIA STATE PRISON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SRN II
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:ELENA
Authorized Official - Last Name:CORREA
Authorized Official - Suffix:
Authorized Official - Credentials:SRN
Authorized Official - Phone:760-348-7000
Mailing Address - Street 1:985 EVELYN AVE
Mailing Address - Street 2:
Mailing Address - City:BRAWLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92227-5169
Mailing Address - Country:US
Mailing Address - Phone:760-344-3134
Mailing Address - Fax:
Practice Address - Street 1:985 EVELYN AVE
Practice Address - Street 2:
Practice Address - City:BRAWLEY
Practice Address - State:CA
Practice Address - Zip Code:92227-5169
Practice Address - Country:US
Practice Address - Phone:760-344-3134
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-04
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA511316311Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility