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General NPI Number Information
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NPI Number | 1982034898
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Entity Type | Organization
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Legal Business Name | VILLA DE MARTIN JUDE HOMES ARCHER 2
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Dates
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Enumeration Date | 11/14/2013
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Last Update Date | 11/14/2013
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Provider Practice Location Address
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Address Line | 320 S ARCHER ST
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City | ANAHEIM
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State | CA
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Zip | 92804-2418
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Country | US
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Telephone | 714-776-7610
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Fax | 714-242-9195
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Provider Business Mailing Address
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Address Line | 320 S ARCHER ST
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City | ANAHEIM
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State | CA
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Zip | 92804-2418
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Country | US
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Telephone | 714-776-7610
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Fax | 714-242-9195
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Authorized Official
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Title or Position | OWNER/ADMINSTRATOR
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Name | MR. RAMON LOPEZ
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Credential |
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Telephone | 714-746-4294
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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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