Organization
LOYD'S LIBERTY HOMES, INC
Active
Parent organization
THE MENTOR NETWORK
Organization subpart
Yes
Provider details
NPI number
Legal business name
THE MENTOR NETWORK
Authorized official
NANCY BARGMANN (VICE PRESIDENT)
(909) 483-2505
Entity
Organization
Contact information
Practice address
450 EL PORTAL DR, MERCED, CA 95340-0935
(559) 451-0399
Mailing address
3649 W BEECHWOOD AVE, STE 106, FRESNO, CA 93711-0693
(559) 451-0399
(559) 451-0141
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
LTC60719H
—
CA
Enumeration date
12/27/2007
Last updated
12/27/2007
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