Organization
CDCR-PBSP
Active
Other names
Pelican Bay State Prison
Organization subpart
No
Provider details
NPI number
Authorized official
MAUREEN MCLEAN (HEALTH CARE MANAGER)
(707) 465-1000
Entity
Organization
Contact information
Practice address
5905 LAKE EARL DR, CRESCENT CITY, CA 95532-0001
(707) 465-1000
Mailing address
PO BOX 7000, CRESCENT CITY, CA 95532-0001
(707) 465-1000
Taxonomy
Speciality
Code
Description
License number
State
261QP2400X
Prison Health Clinic/Center
Primary
A043460
CA
Other
Enumeration date
03/07/2007
Last updated
08/22/2020
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