NPI 1932247541

Marcies Manor III Icf

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

Practice location

Address: 1528 Venetian Dr, Stockton, CA 95207-5422
Phone: (209) 952-6122
Fax: (209) 478-3391
Mailing address: 5450 Saint Andrews Dr, Stockton, CA 95219-1918

Authorised official

Name: Marcie H. Patubo
Title: Owner
Phone: (209) 478-3391

Registered specialties

Intellectual and/or Developmental Disabilities Residential Treatment Facility Primary

Residential Treatment Facilities Taxonomy 320600000X Licence 100000773 (CA)

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

Registry record

NPI: 1932247541
Entity type: Organization
NPI issued: 3 Feb 2007
Record last updated: 30 Apr 2008

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.