| NPI | 1164540381 |
|---|---|
| Other Name | ADULT RESIDENTIAL CARE HOME |
| Entity Type | Organization |
| Authorized Contact | NELLIE MERCADO GAVINO Licensee Administor 916-447-2748 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness (Licence: CA 340313039) |
| Enumeration Date | 2007-03-26 |
| Last Update Date | 2020-08-22 |