CHUCKAWALA VALLWY STATE PRISON
NPI 1356701494
Clinic/Center - Prison Health in Blythe, CA

Q: What is the provider's specialty?

The provider's specialty is Clinic/Center with taxonomy code 261QP2400X and a focus in Prison Health.

Active since March 02, 2016

19025 WILEYS WELL RD, BLYTHE, CA 92225(760) 922-5300 Get Directions Write a Review

NPPES record last updated: March 2, 2016. Verified against the NPPES registry weekly; last sync: July 19, 2026.

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NPI Profile Information
Primary Taxonomy
Authorized Official
Other Providers Same Location
Frequently Asked Questions

Organization
Clinic/Center
Prison Health

About CHUCKAWALA VALLWY STATE PRISON

This page provides the complete NPI Profile along with additional information for Chuckawala Vallwy State Prison, a provider established in Blythe, California operating as a Clinic/center, focusing in prison health . The healthcare provider is registered in the NPI registry with number 1356701494 assigned on March 2016. The practitioner's primary taxonomy code is 261QP2400X with license number 63848 (CA). The provider is registered as an organization and their NPI record was last updated 10 years ago. The authorized official of this NPI record is Dr. Michael Lee M.d. (Cme)

NPI: 1356701494 Verify this NPI
Provider Name: CHUCKAWALA VALLWY STATE PRISON
Entity Type: Organization
Location Address: 19025 WILEYS WELL RD BLYTHE, CA 92225
Location Phone: (760) 922-5300
Mailing Address: 19025 WILEYS WELL RD BLYTHE, CA 92225
Mailing Phone: (760) 922-5300
Is Sole Proprietor?: No
Is Organization Subpart?: No
Enumeration Date: 03-02-2016
Last Update Date: 03-02-2016
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Specialty - Primary Taxonomy

The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Classification: Clinic/Center Prison Health
Taxonomy Code: 261QP2400X
Type: Ambulatory Health Care Facilities
License No.: 63848
License State: CA

Authorized Official

The authorized official is the designated individual with the legal authority to make changes to the provider’s official NPI record. For organizations, the authorized official must be a general partner, chairman of the board, CEO, CFO or a direct owner holding at least a 5 percent stake in the medical organization.

Authorized Official Name: DR. MICHAEL LEE M.D.
Authorized Official Title: CME
Authorized Official Phone: (760) 922-5300