# CARCIDO'S ICF 2

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1033326798
- **Authorized official:** MRS. MEDINA CARCIDO (LICENSEE)
- **Authorized official phone:** (209) 471-0814

## Contact information

- **Practice address:** 1949 WAGNER HEIGHTS RD, STOCKTON, CA 95209-1846
- **Practice address phone:** (209) 951-2074
- **Mailing address:** PO BOX 690097, STOCKTON, CA 95269-0097

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 320600000X | Intellectual and/or Developmental Disabilities Residential Treatment Facility | LTC60707F | CA | Yes |

## Other

- **Enumeration date:** 05/16/2007
- **Last updated:** 08/22/2020