# OUR LADY OF MERCY HOME 2

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

## Provider details

- **NPI number:** 1508131491
- **Authorized official:** MRS. LYDIA S DEBASTIAN RN (OWNER/LICENCEE)
- **Authorized official phone:** (909) 578-5453

## Contact information

- **Practice address:** 3845 S MORGANFIELD AVE, WEST COVINA, CA 91792-3238
- **Practice address phone:** (909) 444-5796
- **Practice address fax:** (909) 594-3604
- **Mailing address:** 3845 S MORGANFIELD AVE, WEST COVINA, CA 91792-3238
- **Mailing address phone:** (909) 444-5796
- **Mailing address fax:** (909) 594-3604

## Taxonomy

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

## Other

- **Enumeration date:** 03/12/2012
- **Last updated:** 03/12/2012