Provider Demographics
NPI:1164853008
Name:CACHUELA ICF/DDN HOME, INC.
Entity Type:Organization
Organization Name:CACHUELA ICF/DDN HOME, INC.
Other - Org Name:OLMSTEAD HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:OSCAR
Authorized Official - Middle Name:
Authorized Official - Last Name:CACHUELA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-749-5658
Mailing Address - Street 1:1721 N GREENGROVE ST
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92865-4616
Mailing Address - Country:US
Mailing Address - Phone:714-921-2987
Mailing Address - Fax:
Practice Address - Street 1:1721 N GREENGROVE ST
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92865-4616
Practice Address - Country:US
Practice Address - Phone:714-921-2987
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-03
Last Update Date:2013-12-03
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