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General NPI Number Information
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NPI Number | 1275215782
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Entity Type | Organization
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Legal Business Name | WARM HEART RESIDENTIAL CORP
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Dates
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Enumeration Date | 08/03/2023
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Last Update Date | 08/03/2023
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Provider Practice Location Address
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Address Line | 3616 LANGTRY AVE
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City | ATWATER
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State | CA
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Zip | 95301-5425
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Country | US
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Telephone | 209-355-1111
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 216
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City | ATWATER
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State | CA
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Zip | 95301-0216
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Country | US
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Telephone | 209-355-3111
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DEXTER A COWARD JR.
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Credential |
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Telephone | 209-355-3111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 315P00000X
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Taxonomy Name | Intellectual Disabilities Intermediate Care Facility
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License Number |
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License Number State |
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