Healthcare Provider Details

I. General information

NPI: 1336445212
Provider Name (Legal Business Name): PTL PEDIATRIC DAYCARE CENTERS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2011
Last Update Date: 02/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1890 BEDFORD DR
CHICO CA
95928-7352
US

IV. Provider business mailing address

PO BOX 3726
CHICO CA
95927-3726
US

V. Phone/Fax

Practice location:
  • Phone: 530-343-8344
  • Fax: 530-343-6683
Mailing address:
  • Phone: 530-891-0657
  • Fax: 530-891-8853

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code385HR2065X
TaxonomyChild Physical Disabilities Respite Care
License Number550000327
License Number StateCA

VIII. Authorized Official

Name: ROBERT ALLEN CLARK
Title or Position: ADMINISTRATOR
Credential:
Phone: 530-891-0657