Healthcare Provider Details

I. General information

NPI: 1013927102
Provider Name (Legal Business Name): MARNA E. CARLI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 06/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5577 CARLI CT
PARADISE CA
95969
US

IV. Provider business mailing address

5577 CARLI CT
PARADISE CA
95969
US

V. Phone/Fax

Practice location:
  • Phone: 530-872-2296
  • Fax: 530-872-2297
Mailing address:
  • Phone: 530-872-2296
  • Fax: 530-872-2297

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number230000299
License Number StateCA

VIII. Authorized Official

Name: ROBERT M CARLI
Title or Position: ADMINISTRATOR
Credential:
Phone: 530-872-2296