PACIFIC HOME CA is a residential treatment facility, intellectual and/or developmental disabilities in Carson, CA. The provider is a residential facility that provides habilitation services and other care and treatment to adults or children diagnosed with developmental and intellectual disabilities and are not able to live independently. PACIFIC HOME CA NPI is 1164663746. The provider is registered as an organization entity type.
The provider's business location address is:
254 E 220TH ST
CARSON, CA
ZIP 90745-012
Phone: (310) 518-5178
Fax: (310) 518-5005
The provider's authorized official is Rosaline B Tanglao .
The authorized official title is Owner/licensee and has the following contact phone number (310) 518-5178.
The CLIA number assigned to this NPI record is 05D1019730 - intermediate care facility for mentally retarded with a certificate type of Certificate of Waiver.
The enumeration date for this NPI number is 3/12/2009 and was last updated on 3/12/2009.