Organization
LOYD'S LIBERTY HOMES, INC
Active
Parent organization
THE MENTOR NETWORK
Other names
Loyd's Libert Homes - San Jose
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
3567 SAN JOSE AVE, MERCED, CA 95348-2225
(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
—
LTC80308G
—
CA
Enumeration date
12/27/2007
Last updated
12/27/2007
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