Provider Demographics
NPI:1114731312
Name:COUNTY OF TULARE
Entity type:Organization
Organization Name:COUNTY OF TULARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DEPUTY HHS DIRECTOR, PH OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:STACI
Authorized Official - Middle Name:
Authorized Official - Last Name:CHASTAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-624-8480
Mailing Address - Street 1:5957 S MOONEY BLVD
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93277-9394
Mailing Address - Country:US
Mailing Address - Phone:559-624-8480
Mailing Address - Fax:
Practice Address - Street 1:1960 W SCRANTON AVE
Practice Address - Street 2:
Practice Address - City:PORTERVILLE
Practice Address - State:CA
Practice Address - Zip Code:93257-9358
Practice Address - Country:US
Practice Address - Phone:559-624-8480
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF TULARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-02-06
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2400XAmbulatory Health Care FacilitiesClinic/CenterPrison Health
No251K00000XAgenciesPublic Health or Welfare
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center