# SANTA LUCIA ICF-DDH

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

## Provider details

- **NPI number:** 1871774125
- **Authorized official:** MRS. LEONILA REALEZA PADILLA (ADMINISTRATOR)
- **Authorized official phone:** (707) 655-3225

## Contact information

- **Practice address:** 11 MARSHALL WAY, VALLEJO, CA 94589-1946
- **Practice address phone:** (707) 731-2747
- **Practice address fax:** (707) 731-2748
- **Mailing address:** 11 MARSHALL WAY, VALLEJO, CA 94589-1946
- **Mailing address phone:** (707) 731-2747
- **Mailing address fax:** (707) 731-2748

## Taxonomy

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

## Other

- **Enumeration date:** 11/15/2007
- **Last updated:** 11/15/2007

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | LTC61065F | MEDICAL PROVIDER NUMBER | CA |