Organization
PRODIGY HEALTHCARE, INC.
Active
Parent organization
PRODIGY HEALTHCARE, INC.
Organization subpart
Yes
Provider details
NPI number
Legal business name
PRODIGY HEALTHCARE, INC.
Authorized official
MR. JAGDIP DHANDA (CEO)
(559) 892-9452
Entity
Organization
Contact information
Practice address
311 E MERCED ST, (ROOMS 1-7 , CONFERENCE ROOM ), FOWLER, CA 93625-2316
(888) 885-5580
(888) 885-5580
Mailing address
PO BOX 820, FOWLER, CA 93625-0820
(888) 885-5580
(888) 885-5580
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PENDING
MEDI-CAL
CA
Enumeration date
02/05/2011
Last updated
11/27/2013
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