# CARCIDO'S ICF 4

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

## Provider details

- **NPI number:** 1063628972
- **Authorized official:** MRS. MEDINA CARCIDO (LICENSEE)
- **Authorized official phone:** (209) 471-0814

## Contact information

- **Practice address:** 8344 CHEVALIER WAY, STOCKTON, CA 95210-2277
- **Practice address phone:** (209) 476-1749
- **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 | LTC60901F | CA | Yes |

## Other

- **Enumeration date:** 05/15/2007
- **Last updated:** 08/22/2020