Provider Demographics
NPI:1255460176
Name:CORCORAN DISTRICT HOSPITAL
Entity type:Organization
Organization Name:CORCORAN DISTRICT HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
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:#3
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:#3
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?:Yes
Parent Organization LBN:CORCORAN DISTRICT HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-05
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA040000087261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARHM53932GMedicaid
CA058591Medicare Oscar/Certification