Organization
APTUS PACEM, LLC
Active
Other names
FAIR OAKS MANOR III
Organization subpart
No
Provider details
NPI number
Authorized official
TEODULO BONZON (MANAGER)
(818) 846-4469
Entity
Organization
Contact information
Practice address
5035 E ECHO ST, LOS ANGELES, CA 90042-3915
(818) 846-4469
Mailing address
3013 ANNITA DR, GLENDALE, CA 91206-1302
(818) 846-4469
(818) 457-5577
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
197609670
COMMUNITY BASED RESIDENTIAL TREATMENT FACILITY, MENTAL ILLNESS
CA
Enumeration date
12/30/2019
Last updated
12/30/2019
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