Organization
MILESTONES OF DEVELOPMENT, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CYNTHIA MACK (ADMINISTRATOR)
(707) 644-0496
Entity
Organization
Contact information
Practice address
200 LYTHAM WAY, VALLEJO, CA 94591-4317
(707) 644-0496
Mailing address
1 FLORIDA ST, VALLEJO, CA 94590-5000
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
LTC60049G
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7005713
EDS PIN NUMBER
CA
01
—
LTC60049G
PROVIDER NUMBER
CA
Enumeration date
05/21/2007
Last updated
08/22/2020
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