Provider Demographics
NPI:1164669446
Name:LARK SPRING TERRACE INCORPORATED
Entity Type:Organization
Organization Name:LARK SPRING TERRACE INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/CFO/SECRETARY
Authorized Official - Prefix:MRS
Authorized Official - First Name:LOURDES OFELIA
Authorized Official - Middle Name:AGUINALDO
Authorized Official - Last Name:ABARIENTOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-398-6898
Mailing Address - Street 1:22504 LARK SPRING TER
Mailing Address - Street 2:
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91765-2956
Mailing Address - Country:US
Mailing Address - Phone:909-860-2622
Mailing Address - Fax:909-860-2622
Practice Address - Street 1:22504 LARK SPRING TER
Practice Address - Street 2:
Practice Address - City:DIAMOND BAR
Practice Address - State:CA
Practice Address - Zip Code:91765-2956
Practice Address - Country:US
Practice Address - Phone:909-860-2622
Practice Address - Fax:909-860-2622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-08
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities