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General NPI Number Information
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NPI Number | 1316164379
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Entity Type | Organization
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Legal Business Name | CARPENTER GUEST HOMES INC
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Dates
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Enumeration Date | 04/19/2007
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Last Update Date | 07/14/2008
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Provider Practice Location Address
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Address Line | 3446 POCK LN
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City | STOCKTON
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State | CA
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Zip | 95205-8022
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Country | US
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Telephone | 209-932-0368
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Fax | 209-932-0668
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Provider Business Mailing Address
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Address Line | 2482 CARPENTER RD
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City | STOCKTON
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State | CA
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Zip | 95205
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Country | US
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Telephone | 209-932-0368
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Fax | 209-932-0668
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Authorized Official
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Title or Position | LICENSEE/ADMIN
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Name | MRS. ESTRELLA L. JOSE
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Credential |
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Telephone | 209-462-4239
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number | 100000685
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 261QD1600X
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Taxonomy Name | Developmental Disabilities Clinic/Center
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License Number | 100000685
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License Number State | CA
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