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Organization
PARADISE VALLEY ICF DDH INC
Active
Organization
PARADISE VALLEY ICF DDH INC
Active
Other names
Paradise Valley ICFDDH Inc
Organization subpart
No
Provider details
NPI number
Authorized official
NIMFA PUNZALAN (OWNER/ LICENSEE)
(707) 655-3225
Entity
Organization
Contact information
Practice address
3313 EL PINOLE WAY, FAIRFIELD, CA 94533-7208
(707) 655-3225
(707) 652-5168
Mailing address
3313 EL PINOLE WAY, FAIRFIELD, CA 94533-7208
(707) 655-3225
(707) 652-5168
Taxonomy
Speciality
Code
Description
License number
State
310500000X
Mental Illness Intermediate Care Facility
010000432
CA
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
—
—
Other
Enumeration date
05/22/2018
Last updated
05/22/2018
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