Healthcare Provider Details

I. General information

NPI: 1609033588
Provider Name (Legal Business Name): PTL PEDIATRIC DAYCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2008
Last Update Date: 05/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1890 BEDFORD DR
CHICO CA
95928-7352
US

IV. Provider business mailing address

1890 BEDFORD DR
CHICO CA
95928-7352
US

V. Phone/Fax

Practice location:
  • Phone: 530-343-8344
  • Fax: 530-343-6683
Mailing address:
  • Phone: 530-343-8344
  • Fax: 530-343-6683

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number550000327
License Number StateCA

VIII. Authorized Official

Name: CYNTHIA D BURNS
Title or Position: OWNER
Credential: R.N.
Phone: 530-343-8344