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General NPI Number Information
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NPI Number | 1689753444
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Entity Type | Organization
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Legal Business Name | MIDOMAR HOMES INC.
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Dates
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Enumeration Date | 11/03/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 17807 BELSHIRE AVE
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City | ARTESIA
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State | CA
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Zip | 90701-4234
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Country | US
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Telephone | 562-865-3337
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Fax | 562-865-3337
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Provider Business Mailing Address
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Address Line | 17807 BELSHIRE AVE
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City | ARTESIA
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State | CA
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Zip | 90701-4234
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Country | US
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Telephone | 562-865-3337
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Fax | 562-865-3337
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Authorized Official
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Title or Position | OWNER
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Name | MRS. ADORACION MANALAD PALISOC
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Credential | M.D.
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Telephone | 714-974-4321
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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 |
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License Number State | CA
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