Provider Demographics
NPI:1376639609
Name:CACHUELA ICFDDN HOME INC
Entity Type:Organization
Organization Name:CACHUELA ICFDDN HOME INC
Other - Org Name:CACHUELA ICF DDN HOME OLMSTEAD HOME CASA DE YORBA LINDA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:OSCAR
Authorized Official - Middle Name:RIVERA
Authorized Official - Last Name:CACHUELA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-420-4486
Mailing Address - Street 1:1315 NORTH TUSTIN
Mailing Address - Street 2:SUITE I399
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92867-5042
Mailing Address - Country:US
Mailing Address - Phone:714-921-2987
Mailing Address - Fax:714-637-4604
Practice Address - Street 1:1721 N GREENGROVE
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:714-283-4621
Practice Address - Fax:714-283-4621
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities