PRODIGY HEALTHCARE, INC. (NPI# 1710284229) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1710284229 |
| Entity Type | Organization |
| Organization Name | PRODIGY HEALTHCARE, INC. |
| Practice Address |
701 E Main St (rooms 104, 501, 701) Fowler CA 93625-2423 |
| Mailing Address |
Po Box 820 Fowler CA 93625-0820 |
| Practice Telephone | 8888855580 |
| Practice Fax Number | 8888855580 |
| Mailing Telephone | 8888855580 |
| Mailing Fax Number | 8888855580 |
| Enumeration Date | 2011-02-17 |
| Last Update Date | 2013-06-28 |
| Authorized Official Name | MR. JAGDIP DHANDA (CEO) |
| Authorized Official Telephone | 5598929452 |
| Is Organization Subpart | Y |
| Parent Organization Name | PRODIGY HEALTHCARE, INC. |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QR0405X |
Clinic/Center Specialization: Rehabilitation, Substance Use Disorder |
PENDING | CA | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | DRUG MEDI-CAL | PENDING | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154718401 | Prodigy Healthcare, Inc. | Clinic/Center | 1 Tiller Ave., Caruthers, CA 93609 | 2015-04-23 |
| 1518354869 | Prodigy Healthcare, Inc. | Clinic/Center | 13620 S. Kincaid, Caruthers, CA 93609 | 2015-04-23 |
| 1144617176 | Prodigy Healthcare, Inc. | Clinic/Center | 2580 W Tahoe Ave, Caruthers, CA 93609-9475 | 2015-04-16 |
| 1972800340 | Prodigy Healthcare, Inc. | Clinic/Center | 701 E Walter Ave, (rooms C10 and C11), Fowler, CA 93625-9792 | 2011-02-22 |
| 1245537612 | Prodigy Healthcare, Inc. | Clinic/Center | 975 East Adams Avenue, (rooms 1-5,offices 1-3), Fowler, CA 93625 | 2011-02-22 |
| 1689970766 | Prodigy Healthcare, Inc. | Clinic/Center | 1191 P St, (mo, Rooms 1-20), Firebaugh, CA 93622-2230 | 2011-02-07 |
| 1134425200 | Prodigy Healthcare, Inc. | Clinic/Center | 1666 Saipan Ave, (rooms 1-8), Firebaugh, CA 93622-2438 | 2011-02-07 |
| 1306142484 | Prodigy Healthcare, Inc. | Clinic/Center | 1600 16th St, (mo, 1-19,25-31,40), Firebaugh, CA 93622-2407 | 2011-02-07 |
| 1316243546 | Prodigy Healthcare, Inc. | Clinic/Center | 1976 Morris Kyle Dr, (mo,101-2,301-5,404,501-5,601-5,701-3,801-14,901-7,co), Firebaugh, CA 93622-9711 | 2011-02-05 |
| 1497051627 | Prodigy Healthcare, Inc. | Clinic/Center | 311 E Merced St, (rooms 1-7, Conference Room ), Fowler, CA 93625-2316 | 2011-02-05 |
| Street Address |
701 E MAIN ST (ROOMS 104, 501, 701) |
| City | FOWLER |
| State | CA |
| Zip Code | 93625-2423 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972849412 | Christina Reyna Carrillo | Social Worker | 220 6th St., Fowler, CA 93625 | 2013-01-02 |
| 1760770010 | Danielle Luevano-baker | Counselor | 949 Maple Avenue, Fowler, CA 93625 | 2011-07-20 |
| 1245537612 | Prodigy Healthcare, Inc. | Clinic/Center | 975 East Adams Avenue, (rooms 1-5,offices 1-3), Fowler, CA 93625 | 2011-02-22 |
| 1760547160 | Nia Healthcare Svs Inc | Skilled Nursing Facility | 8448 E Adams, Fowler, CA 93625 | 2006-12-26 |
| 1457383358 | Harry Chen | Family Medicine | 128 N 6th St, Fowler, CA 93625 | 2006-07-07 |
| 1982182127 | Harry Chen, M.d., Inc., A Professional Corporation | Clinic/Center | 128 N 6th St, Fowler, CA 93625 | 2018-07-31 |
| 1336632603 | Fowler Care Holdings, LLC | Skilled Nursing Facility | 8448 E Adams Ave, Fowler, CA 93625 | 2018-06-12 |
| 1427494061 | Bobby Aulakh | Family Medicine | 106 E Main St, Fowler, CA 93625 | 2013-05-21 |
| 1992957088 | Kulraj Singh Sidhu | Internal Medicine | 311 E Merced St, Fowler, CA 93625 | 2008-10-21 |
| 1346363025 | Fowler Usd | Local Education Agency (LEA) | 658 E Adams Ave, Fowler, CA 93625-2111 | 2007-04-09 |
| Find all providers in zip 93625 | ||||
| Taxonomy Code | 261QR0405X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Rehabilitation, Substance Use Disorder |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972800340 | Prodigy Healthcare, Inc. | Clinic/Center | 701 E Walter Ave, (rooms C10 and C11), Fowler, CA 93625-9792 | 2011-02-22 |
| 1245537612 | Prodigy Healthcare, Inc. | Clinic/Center | 975 East Adams Avenue, (rooms 1-5,offices 1-3), Fowler, CA 93625 | 2011-02-22 |
| 1497051627 | Prodigy Healthcare, Inc. | Clinic/Center | 311 E Merced St, (rooms 1-7, Conference Room ), Fowler, CA 93625-2316 | 2011-02-05 |
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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.