| NPI | 1730130097 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CARLA A CASTANEDA Chief Deputy Director 916-654-2822 |
| Organization Subpart ? | No |
| Primary Taxonomy | 315P00000X Intermediate Care Facility, Mentally Retarded (Licence: CA 170000774) |
| Additional Taxonomies | 320900000X Community Based Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities (Licence: CA 170000774) |
| 333600000X Pharmacy (Licence: CA 170000774) | |
| 313M00000X Nursing Facility/Intermediate Care Facility (Licence: CA 170000774) | |
| 315P00000X Intermediate Care Facility, Mentally Retarded | |
| Enumeration Date | 2006-05-12 |
| Last Update Date | 2021-06-29 |