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General NPI Number Information
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NPI Number | 1700068111
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Entity Type | Organization
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Legal Business Name | BUTLER VALLEY # 2
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Dates
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Enumeration Date | 11/28/2007
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Last Update Date | 11/28/2007
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Provider Practice Location Address
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Address Line | 3971 F ST
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City | EUREKA
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State | CA
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Zip | 95503-6003
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Country | US
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Telephone | 707-442-7313
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Fax |
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Provider Business Mailing Address
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Address Line | 5245 VANCE ST
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City | EUREKA
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State | CA
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Zip | 95503-6350
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Country | US
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Telephone | 707-442-2451
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Fax | 707-445-1887
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | SUZETTE OTT
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Credential |
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Telephone | 707-442-2451
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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 | LTC60133F
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License Number State | CA
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