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General NPI Number Information
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NPI Number | 1952072019
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Entity Type | Organization
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Legal Business Name | CIRCLE C RANCH INC
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Dates
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Enumeration Date | 09/27/2021
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Last Update Date | 09/27/2021
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Provider Practice Location Address
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Address Line | 342 BEST RD
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City | STOCKTON
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State | CA
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Zip | 95215-9711
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Country | US
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Telephone | 916-295-8582
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Fax |
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Provider Business Mailing Address
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Address Line | 342 BEST RD
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City | STOCKTON
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State | CA
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Zip | 95215-9711
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Country | US
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Telephone | 916-295-8582
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. RAYNISHA MCDONALD
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Credential |
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Telephone | 916-295-8582
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number |
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License Number State |
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