Organization
PACIFIC HOME CA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ROSALINE B TANGLAO RC (OWNER/LICENSEE)
(310) 518-5178
Entity
Organization
Contact information
Practice address
254 E 220TH ST, CARSON, CA 90745-3012
(310) 518-5178
(310) 518-5005
Mailing address
254 E 220TH ST, CARSON, CA 90745-3012
(310) 518-5178
(310) 518-5005
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
—
CA
Other
Enumeration date
03/12/2009
Last updated
03/12/2009
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