Provider Demographics
NPI:1275215782
Name:WARM HEART RESIDENTIAL CORP
Entity Type:Organization
Organization Name:WARM HEART RESIDENTIAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEXTER
Authorized Official - Middle Name:A
Authorized Official - Last Name:COWARD
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:209-355-3111
Mailing Address - Street 1:PO BOX 216
Mailing Address - Street 2:
Mailing Address - City:ATWATER
Mailing Address - State:CA
Mailing Address - Zip Code:95301-0216
Mailing Address - Country:US
Mailing Address - Phone:209-355-3111
Mailing Address - Fax:
Practice Address - Street 1:3616 LANGTRY AVE
Practice Address - Street 2:
Practice Address - City:ATWATER
Practice Address - State:CA
Practice Address - Zip Code:95301-5425
Practice Address - Country:US
Practice Address - Phone:209-355-1111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-03
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities