Provider Demographics
NPI:1003245499
Name:PSB HOMES INC. DRACAENA HOMES
Entity Type:Organization
Organization Name:PSB HOMES INC. DRACAENA HOMES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PRISCILLA
Authorized Official - Middle Name:
Authorized Official - Last Name:BUSTAMANTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-926-2352
Mailing Address - Street 1:8241 DRACAENA DR
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90620-4014
Mailing Address - Country:US
Mailing Address - Phone:714-826-6652
Mailing Address - Fax:714-779-7268
Practice Address - Street 1:8241 DRACAENA DR
Practice Address - Street 2:
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90620-4014
Practice Address - Country:US
Practice Address - Phone:714-826-6652
Practice Address - Fax:714-779-7268
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-05
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities