Provider Demographics
NPI:1821621764
Name:CORRECTIONS AND REHABILITATION
Entity Type:Organization
Organization Name:CORRECTIONS AND REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:STATEWIDE CHIEF MEDICAL EXECUTIVE
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:THARATT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-691-9913
Mailing Address - Street 1:300 PRISON ROAD
Mailing Address - Street 2:
Mailing Address - City:REPRESA
Mailing Address - State:CA
Mailing Address - Zip Code:95671-4071
Mailing Address - Country:US
Mailing Address - Phone:916-985-2561
Mailing Address - Fax:916-608-3112
Practice Address - Street 1:300 PRISON ROAD
Practice Address - Street 2:
Practice Address - City:REPRESA
Practice Address - State:CA
Practice Address - Zip Code:95671-4071
Practice Address - Country:US
Practice Address - Phone:916-985-2561
Practice Address - Fax:916-608-3112
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CORRECTIONS & REHABILITATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-02-19
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy