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Organization
PARADISE VALLEY ICF-DDH
Active
Organization
PARADISE VALLEY ICF-DDH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. NIMFA REALEZA PADILLA (OWNER)
(707) 425-2202
Entity
Organization
Contact information
Practice address
3313 EL PINOLE WAY, FAIRFIELD, CA 94533-7208
(707) 425-2202
(707) 425-6060
Mailing address
3313 EL PINOLE WAY, FAIRFIELD, CA 94533-7208
(707) 425-2202
(707) 425-6060
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
010000432
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LTC61010F
MEDICAL PROVIDER NUMBER
CA
Enumeration date
11/15/2007
Last updated
11/15/2007
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