Organization
REIMS ICFDD-H
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DOMINADOR DELACRUZ PAJARITO (LICENSEE)
(209) 366-2119
Entity
Organization
Contact information
Practice address
22801 N SOWLES RD, ACAMPO, CA 95220-9608
(209) 366-2119
(209) 366-2119
Mailing address
22801 N SOWLES RD, ACAMPO, CA 95220-9608
(209) 366-2119
(209) 366-2119
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
CA
Other
Enumeration date
10/11/2007
Last updated
10/11/2007
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