Organization
CCI, INC.
Active
Other names
Park House
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DANIEL JAMES FISHER M.ED. (PRESIDENT)
(925) 560-0124
Entity
Organization
Contact information
Practice address
39523 SUNDALE DR, FREMONT, CA 94538-1927
(510) 623-8231
(925) 560-0125
Mailing address
PO BOX 112, ALAMO, CA 94507-0112
(925) 560-0124
(925) 560-0125
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
LTC60320F
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
LTC60320F
—
CA
Enumeration date
02/12/2007
Last updated
08/22/2020
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