Organization
MARCIES MANOR III ICF
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARCIE H. PATUBO (OWNER)
(209) 478-3391
Entity
Organization
Contact information
Practice address
1528 VENETIAN DR, STOCKTON, CA 95207-5422
(209) 952-6122
(209) 478-3391
Mailing address
5450 SAINT ANDREWS DR, STOCKTON, CA 95219-1918
(209) 478-3391
(209) 478-3391
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
100000773
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
LTC61051F
—
CA
Enumeration date
02/03/2007
Last updated
04/30/2008
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