Organization
MULE CREEK SATE PRISON
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAVID SMILEY (CEO)
(209) 274-4911
Entity
Organization
Contact information
Practice address
9266 DAIRY CT, ELK GROVE, CA 95624-3583
(209) 274-4911
Mailing address
9266 DAIRY CT, ELK GROVE, CA 95624-3583
(209) 274-4911
Taxonomy
Speciality
Code
Description
License number
State
302F00000X
Exclusive Provider Organization
Primary
LCF35817
CA
Other
Enumeration date
10/10/2014
Last updated
10/10/2014
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