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General NPI Number Information
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NPI Number | 1609033588
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Entity Type | Organization
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Legal Business Name | PTL PEDIATRIC DAYCARE
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Dates
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Enumeration Date | 05/19/2008
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Last Update Date | 05/19/2008
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Provider Practice Location Address
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Address Line | 1890 BEDFORD DR
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City | CHICO
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State | CA
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Zip | 95928-7352
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Country | US
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Telephone | 530-343-8344
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Fax | 530-343-6683
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Provider Business Mailing Address
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Address Line | 1890 BEDFORD DR
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City | CHICO
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State | CA
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Zip | 95928-7352
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Country | US
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Telephone | 530-343-8344
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Fax | 530-343-6683
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Authorized Official
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Title or Position | OWNER
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Name | CYNTHIA D BURNS
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Credential | R.N.
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Telephone | 530-343-8344
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 385HR2060X
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Taxonomy Name | Child Intellectual and/or Developmental Disabilities Respite Care
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License Number | 550000327
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License Number State | CA
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