Carcido's Icf 4

NPI 1063628972 - Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities - 320600000X

NPI Details
NPI 1063628972
Enumeration Date 05/15/2007
Last Updated 07/08/2007
Entity Type Healthcare Provider
Active Over 9 years ago
Authorized Information
Name MEDINA MEDINA
Position LICENSEE
Phone (209) 476-1749
Fax
Practice Location
8344 CHEVALIER WAY
STOCKTON CA, 95210-2277, US
Phone (209) 476-1749
Fax
Business Location
PO BOX 690097
STOCKTON CA, 95269-0097, US
Phone
Fax
Toxanomy
Taxonomy Code 320600000X
License State California
License Number LTC60901F
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According to our database, Carcido's Icf 4 NPI is 1063628972, taxonomy code is 320600000X and license number is LTC60901F, license state is located at California. Carcido's Icf 4 physically located at 8344 Chevalier Way, Stockton CA, 95210-2277. NPI Number 1033115704 has the healthcare provider type.

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1063628972 NPI number is provided on an as is basis without warranty of any kind. 1063628972 is maintained by the National Plan & Provider Enumeration System. The contents of Carcido's Icf 4 are for informational purposes only.