Provider Demographics
NPI:1255334595
Name:CORCORAN DISTRICT HOSPITAL
Entity type:Organization
Organization Name:CORCORAN DISTRICT HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-992-5051
Mailing Address - Street 1:1310 HANNA AVE
Mailing Address - Street 2:
Mailing Address - City:CORCORAN
Mailing Address - State:CA
Mailing Address - Zip Code:93212-2314
Mailing Address - Country:US
Mailing Address - Phone:559-992-5051
Mailing Address - Fax:559-992-3972
Practice Address - Street 1:1310 HANNA AVE
Practice Address - Street 2:
Practice Address - City:CORCORAN
Practice Address - State:CA
Practice Address - Zip Code:93212-2314
Practice Address - Country:US
Practice Address - Phone:559-992-5051
Practice Address - Fax:559-992-3972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-31
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA040000087282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALTC30349FMedicaid
CAZZT40349FMedicaid
CAZZT30349FMedicaid
CALTC30349FMedicaid
CAZZT30349FMedicaid