Organization
PARADISE VALLEY ICF DDH INC
Active
Other names
Paradise Valley ICFDDH Inc
Organization subpart
No
Provider details
NPI number
Authorized official
NIMFA PUNZALAN (OWNER/ LICENSEE)
(707) 655-3225
Entity
Organization
Contact information
Practice address
3313 EL PINOLE WAY, FAIRFIELD, CA 94533-7208
(707) 655-3225
(707) 652-5168
Mailing address
3313 EL PINOLE WAY, FAIRFIELD, CA 94533-7208
(707) 655-3225
(707) 652-5168
Taxonomy
Speciality
Code
Description
License number
State
310500000X
Mental Illness Intermediate Care Facility
010000432
CA
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
—
—
Other
Enumeration date
05/22/2018
Last updated
05/22/2018
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