NPI 1063628972

Carcido's Icf 4

Organisation Intellectual and/or Developmental Disabilities Residential Treatment Facility Stockton, CA

Practice location

Address: 8344 Chevalier Way, Stockton, CA 95210-2277
Phone: (209) 476-1749
Mailing address: PO Box 690097, Stockton, CA 95269-0097

Authorised official

Name: Medina Carcido
Title: Licensee
Phone: (209) 471-0814

Registered specialties

Intellectual and/or Developmental Disabilities Residential Treatment Facility Primary

Residential Treatment Facilities Taxonomy 320600000X Licence LTC60901F (CA)

Other Residential Treatment Facility, Intellectual and/or Developmental Disabilities providers in California →

Registry record

NPI: 1063628972
Entity type: Organization
NPI issued: 15 May 2007
Record last updated: 22 Aug 2020

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.