CDCR-PBSP NPI 1437280153

NPI Information

  • NPI: 1437280153
  • Provider Name: CDCR-PBSP
  • Classification: Clinic/Center - 261QP2400X
  • Specialization: Prison Health
  • Entity Type: Organization
  • Other Name: PELICAN BAY STATE PRISON
  • CLIA Number: 05D0890527
  • Address: 5905 LAKE EARL DR
    CRESCENT CITY, CA
    ZIP 95532
  • Phone: (707) 465-1000

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NPI Details

CDCR-PBSP is a prison health clinic center in Crescent City, CA. CDCR-PBSP NPI is 1437280153. The provider is registered as an organization entity type.
The provider Other Name Is Pelican Bay State Prison.

The provider's business location address is:

5905 LAKE EARL DR
CRESCENT CITY, CA
ZIP 95532-001
Phone: (707) 465-1000

The provider's authorized official is Maureen Mclean .
The authorized official title is Health Care Manager and has the following contact phone number (707) 465-1000.

The CLIA number assigned to this NPI record is 05D0890527 - prison with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 3/7/2007 and was last updated on 8/22/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1261QP2400XClinic/CenterPrison HealthA043460CALIFORNIAYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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