Provider Demographics
NPI:1548607393
Name:CALIFORNIA CORRECTIONAL HEALTH CARE SERVICES
Entity Type:Organization
Organization Name:CALIFORNIA CORRECTIONAL HEALTH CARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OF MENTAL HEALTH
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:REKART
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-691-6150
Mailing Address - Street 1:8280 LONG LEAF DRIVE, BLDG D-172
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758
Mailing Address - Country:US
Mailing Address - Phone:916-691-6150
Mailing Address - Fax:
Practice Address - Street 1:8280 LONG LEAF DRIVE
Practice Address - Street 2:BLDG D-172
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95758
Practice Address - Country:US
Practice Address - Phone:916-691-6150
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-03
Last Update Date:2013-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA26603276400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes276400000XHospital UnitsRehabilitation, Substance Use Disorder Unit