Provider Demographics
NPI:1679916985
Name:LANCASTER STATE PRISON
Entity Type:Organization
Organization Name:LANCASTER STATE PRISON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OF MENTAL HEALTH
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:CORNELL
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:661-729-2000
Mailing Address - Street 1:4133 W AVENUE J4
Mailing Address - Street 2:44750 60TH STREET WEST
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93536-6825
Mailing Address - Country:US
Mailing Address - Phone:661-729-2000
Mailing Address - Fax:661-729-6926
Practice Address - Street 1:4133 W AVENUE J4
Practice Address - Street 2:44750 60TH STREET WEST
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93536-6825
Practice Address - Country:US
Practice Address - Phone:661-729-2000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CALIFORIA DEPARTMENT OF CORRECTIONS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-04-17
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY14366251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare