Organization
PENNY GENEVIEVE HARGROVE
Active
Other names
Wings I
Organization subpart
No
Provider details
NPI number
Authorized official
PENNY HARGROVE (EXECUTIVE DIRECTOR)
(925) 754-5184
Entity
Organization
Contact information
Practice address
2427 DESRYS BLVD, ANTIOCH, CA 94509-4324
(925) 776-8386
Mailing address
P.O. BOX 1295, ANTIOCH, CA 94509-0129
(925) 776-8386
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
LTC60761F
CA
Other
Enumeration date
02/28/2007
Last updated
06/20/2008
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