Organization
CARCIDO'S ICF 3
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MEDINA CARCIDO (LICENSEE)
(209) 471-0814
Entity
Organization
Contact information
Practice address
2721 JIMENEZ WAY, STOCKTON, CA 95209-1774
(209) 951-4411
Mailing address
PO BOX 690097, STOCKTON, CA 95269-0097
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
LTC60768F
CA
Other
Enumeration date
05/16/2007
Last updated
08/22/2020
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