Provider Demographics
NPI:1346618881
Name:CALIFORNIA HUMAN DEVELOPMENT CORPORATION
Entity Type:Organization
Organization Name:CALIFORNIA HUMAN DEVELOPMENT CORPORATION
Other - Org Name:STONE HOUSE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSISTANT PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:PARDO-NIETO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-791-5782
Mailing Address - Street 1:3555 SONOMA HWY
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95409-4024
Mailing Address - Country:US
Mailing Address - Phone:707-526-3150
Mailing Address - Fax:707-526-3250
Practice Address - Street 1:3555 SONOMA HWY
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95409-4024
Practice Address - Country:US
Practice Address - Phone:707-526-3150
Practice Address - Fax:707-526-3250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-14
Last Update Date:2015-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA490010AN324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility