Provider Demographics
NPI:1457765166
Name:COMMUNITY POOL FOR THE HANDICAPPED, INC.
Entity Type:Organization
Organization Name:COMMUNITY POOL FOR THE HANDICAPPED, INC.
Other - Org Name:BUTCHIE'S POOL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:RODERICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-671-4373
Mailing Address - Street 1:144 GIBSON AVE
Mailing Address - Street 2:
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95991-5513
Mailing Address - Country:US
Mailing Address - Phone:530-671-4373
Mailing Address - Fax:530-671-4352
Practice Address - Street 1:144 GIBSON AVE
Practice Address - Street 2:
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95991-5513
Practice Address - Country:US
Practice Address - Phone:530-671-4373
Practice Address - Fax:530-671-4352
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-20
Last Update Date:2014-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No251K00000XAgenciesPublic Health or Welfare
No251V00000XAgenciesVoluntary or Charitable
No261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain