| NPI | 1568650927 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DOMINADOR DELACRUZ PAJARITO Licensee 209-366-2119 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities |
| Enumeration Date | 2007-10-11 |
| Last Update Date | 2007-10-11 |