Organization
OSTERMAN'S #3 INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DORIS SUSAN OSTERMAN (OWNER ADMINISTRATOR)
(530) 275-2346
Entity
Organization
Contact information
Practice address
4741 PENSACOLA ST, SHASTA LAKE, CA 96019-9773
(530) 275-2346
(530) 275-6674
Mailing address
PO BOX 905, SHASTA LAKE, CA 96019-0905
(530) 275-2346
(530) 275-6674
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LTC 60729G
MEDI-CAL
CA
Enumeration date
08/10/2007
Last updated
08/10/2007
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