Organization
UNITED CARE PROVIDERS-ST MARY'S
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ADOLFO J FESTEJO (VP/CFO)
(818) 802-6363
Entity
Organization
Contact information
Practice address
16765 LAWNWOOD ST, VALINDA, CA 91744-3319
(562) 698-7286
(562) 945-6388
Mailing address
18409 DANCY ST, ROWLAND HEIGHTS, CA 91748-4755
(818) 802-6303
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
960000848
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
LTC80098F
—
CA
Enumeration date
01/28/2006
Last updated
06/30/2009
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