# MARCIES MANOR III ICF

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

## Provider details

- **NPI number:** 1932247541
- **Authorized official:** MARCIE H. PATUBO (OWNER)
- **Authorized official phone:** (209) 478-3391

## Contact information

- **Practice address:** 1528 VENETIAN DR, STOCKTON, CA 95207-5422
- **Practice address phone:** (209) 952-6122
- **Practice address fax:** (209) 478-3391
- **Mailing address:** 5450 SAINT ANDREWS DR, STOCKTON, CA 95219-1918
- **Mailing address phone:** (209) 478-3391
- **Mailing address fax:** (209) 478-3391

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 320600000X | Intellectual and/or Developmental Disabilities Residential Treatment Facility | 100000773 | CA | Yes |

## Other

- **Enumeration date:** 02/03/2007
- **Last updated:** 04/30/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | LTC61051F | — | CA |