CORRECTIONS AND REHABILITATION (NPI# 1053946889) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1053946889 |
| Entity Type | Organization |
| Organization Name | CORRECTIONS AND REHABILITATION |
| Practice Address |
5905 Lake Earl Dr Crescent City CA 95532-0001 |
| Practice Telephone | 7074651000 |
| Practice Fax Number | 7074659178 |
| Mailing Telephone | 7074651000 |
| Mailing Fax Number | 7074659178 |
| Enumeration Date | 2020-03-12 |
| Last Update Date | 2020-03-12 |
| Authorized Official Name | DR. ROBERT STEVEN THARRATT (STATEWIDE CHIEF MEDICAL EXECUTIVE) |
| Authorized Official Telephone | 9166919913 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | Y |
| Parent Organization Name | CORRECTIONS AND REHABILITATION |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 333600000X | Pharmacy | Suppliers |
| Other Name | Type Code |
|---|---|
| Pelican Bay State Prison Pharmacy | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578199741 | Corrections and Rehabilitation | Pharmacy | 16756 Chino Corona Road, Corona, CA 92880 | 2020-03-19 |
| 1275169005 | Corrections and Rehabilitation | Pharmacy | 481 Alta Road, Facility E, Facility Support Building, Room A161, San Diego, CA 92179 | 2020-03-12 |
| 1265067086 | Corrections and Rehabilitation | Pharmacy | 7018 Blair Road, Calipartia, CA 92233 | 2020-03-12 |
| 1134754955 | Corrections and Rehabilitation | Pharmacy | 22844 Virginia Blvd., California City, CA 93505 | 2020-03-12 |
| 1831724657 | Corrections and Rehabilitation | Pharmacy | 570 E. Natoma Street, Folsom, CA 95630 | 2020-03-12 |
| 1427684257 | Corrections and Rehabilitation | Pharmacy | 24863 W. Jayne Avenue, Coalinga, CA 93210 | 2020-03-12 |
| 1356976179 | Corrections and Rehabilitation | Pharmacy | 19005 Wileys Well Road, Blythe, CA 92225 | 2020-03-12 |
| 1326673146 | Corrections and Rehabilitation | Pharmacy | 23500 Kasson Rd Rm 180, Tracy, CA 95304-9595 | 2020-03-12 |
| 1528694379 | Corrections and Rehabilitation | Pharmacy | 21633 Avenue 24 Bldg 1101 Rm 173, Chowchilla, CA 93610-0099 | 2020-03-12 |
| 1417583287 | Corrections and Rehabilitation | Pharmacy | 31626 Highway 101 Dmh Administration Ste 606, Soledad, CA 93960-1020 | 2020-03-12 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | CORRECTIONS AND REHABILITATION, DEPARTMENT OF | 560 E Natoma St, Folsom, CA 95630-2233 |
| Street Address |
5905 LAKE EARL DR |
| City | CRESCENT CITY |
| State | CA |
| Zip Code | 95532-0001 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336293844 | Chan Nguyen | Psychiatry & Neurology | 5905 Lake Earl Dr, Crescent City, CA 95532-0001 | 2007-01-22 |
| 1669951133 | Laura Kluss | Social Worker | 5905 Lake Earl Dr, Crescent City, CA 95532-0001 | 2018-08-07 |
| 1275075079 | Perma Clendenin | Social Worker | 5905 Lake Earl Dr, Crescent City, CA 95532-0001 | 2016-11-09 |
| 1063875854 | Sonja Houston | Psychologist | 5905 Lake Earl Dr, Crescent City, CA 95532-0001 | 2016-03-30 |
| 1689074577 | Olga Panarina | Social Worker | 5905 Lake Earl Dr, Crescent City, CA 95532-0001 | 2014-08-27 |
| 1487072971 | John William Stoner | Psychologist | 5905 Lake Earl Dr, Crescent City, CA 95532-0001 | 2014-04-01 |
| 1003245267 | Nanette Latimer | Pharmacist | 5905 Lake Earl Dr, Pharmacy Department, Crescent City, CA 95532-0001 | 2013-11-07 |
| 1871830513 | Laurina Yu | Psychologist | 5905 Lake Earl Dr, Crescent City, CA 95532 | 2013-01-15 |
| 1962767921 | Nancy Lynn Getman | Pharmacist | 5905 Lake Earl Dr, Pharmacy Department, Crescent City, CA 95532-0001 | 2012-07-05 |
| 1396075693 | Elizabeth Chernow | Psychologist | 5905 Lake Earl Dr, Crescent City, CA 95532-0001 | 2010-01-08 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851501167 | David Linn Archambault | Psychologist | Pelican Bay State Prison 5905 Lake Earl Dr, Crescent City, CA 95532-0001 | 2007-05-23 |
| 1447451083 | Ernest Clifton Leonard | Psychologist | Pelican Bay State Prison, Dept of Mental Health, Crescent City, CA 95532-0001 | 2007-05-30 |
| 1316157688 | Steven W. Veit | Psychologist | Pelican Bay State Prison Mental Health Services, 5905 Lake Earl Drive, Crescent City, CA 95532-7000 | 2007-05-23 |
| 1164595641 | Theodore Donald Utecht | Psychiatry & Neurology | Pelican Bay State Prison, 5905 Lake Earl Dr, Crescent City, CA 95532-7000 | 2006-11-15 |
| Taxonomy Code | 333600000X |
| Grouping | Suppliers |
| Classification | Pharmacy |
| A facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located. |
| Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: added definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568556967 | Enderts Drug Store Inc | Pharmacy | 783 3rd St, Crescent City, CA 95531-4316 | 2006-10-03 |
| 1689756470 | Rural Health Care, Inc. | Pharmacy | 306 Union Ave, Crescent City, FL 32112-4432 | 2006-10-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114528940 | Kaiser Foundation Health Plan Inc | Pharmacy | 4647 Zion Ave Fl4, Rm 4825, San Diego, CA 92120-2507 | 2020-11-06 |
| 1891394128 | Scriptdash Inc | Pharmacy | 4240 Kearny Mesa Rd Ste 107, San Diego, CA 92111-3769 | 2020-10-19 |
| 1235736737 | Scriptdash Inc | Pharmacy | 2360 Qume Dr, San Jose, CA 95131-1838 | 2020-10-07 |
| 1023615150 | Kaiser Foundation Health Plan Inc | Pharmacy | 9550 Escondido Ave Fl 1, Rm 1100, Hesperia, CA 92345-9120 | 2020-10-01 |
| 1033725478 | Happy Med Inc. | Pharmacy | 210 S Grand Ave Ste 116, Glendora, CA 91741-4262 | 2020-09-21 |
| 1366058794 | Joanna Jongae Kim | Pharmacy | 1020 S Anaheim Blvd Ste 101, Anaheim, CA 92805-5807 | 2020-09-21 |
| 1114532231 | Prime Rx San Gabriel, Inc. | Pharmacy | 533 W Las Tunas Dr # 102, San Gabriel, CA 91776-1133 | 2020-09-15 |
| 1164034260 | Tin Rx At The Tower Inc. | Pharmacy | 1801 Colorado Ave Ste 300, Turlock, CA 95382-2708 | 2020-08-19 |
| 1144831702 | Cameron Michael Rehmani Seraji | Pharmacy | 10542 Villa Del Cerro, Santa Ana, CA 92705-1486 | 2020-08-16 |
| 1881204907 | Kaiser Foundation Health Plan Inc | Pharmacy | 25821 S Vermont Ave Fl 4, Rm 4049, Harbor City, CA 90710-3518 | 2020-08-04 |
| Find all providers with the same taxonomy | ||||
| City | CRESCENT CITY |
| Zip Code | 95532 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.