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Organization
THE PARENT COOPERATIVE COMMUNITY
Active
Organization
THE PARENT COOPERATIVE COMMUNITY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. CARLA DEROSE MA, MFT (DIRECTOR)
(916) 965-5135
Entity
Organization
Contact information
Practice address
4426 ILLINOIS AVE, FAIR OAKS, CA 95628-6307
(916) 965-5135
(916) 947-0371
Mailing address
4426 ILLINOIS AVE, FAIR OAKS, CA 95628-6307
(916) 965-5135
(916) 947-0371
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
347004337
CA
Other
Enumeration date
03/07/2017
Last updated
03/07/2017
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