Provider Demographics
NPI:1114356276
Name:ELIZABETH G. SANTOS, INC
Entity Type:Organization
Organization Name:ELIZABETH G. SANTOS, INC
Other - Org Name:ELIZABETH HOMES SAN RICARDO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:G
Authorized Official - Last Name:SANTOS
Authorized Official - Suffix:
Authorized Official - Credentials:BSE
Authorized Official - Phone:714-828-0465
Mailing Address - Street 1:6287 SAN RICARDO WAY
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90620-2845
Mailing Address - Country:US
Mailing Address - Phone:714-527-9145
Mailing Address - Fax:714-736-0931
Practice Address - Street 1:6280 SAN RICARDO WAY
Practice Address - Street 2:
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90620-2846
Practice Address - Country:US
Practice Address - Phone:714-527-9145
Practice Address - Fax:714-736-0931
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-08
Last Update Date:2013-11-08
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