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General NPI Number Information
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NPI Number | 1518148857
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Entity Type | Organization
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Legal Business Name | NEW HAVEN ICF-DDH
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Dates
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Enumeration Date | 11/15/2007
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Last Update Date | 11/15/2007
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Provider Practice Location Address
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Address Line | 100 SAWYER ST
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City | VALLEJO
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State | CA
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Zip | 94589-2039
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Country | US
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Telephone | 707-648-2340
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Fax | 707-648-1549
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Provider Business Mailing Address
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Address Line | 100 SAWYER ST
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City | VALLEJO
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State | CA
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Zip | 94589-2039
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Country | US
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Telephone | 707-648-2340
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Fax | 707-648-1549
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Authorized Official
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Title or Position | OWNER
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Name | MRS. LEONILA REALEZA PADILLA
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Credential |
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Telephone | 707-655-3225
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number | 010000133
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License Number State | CA
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