Provider Demographics
NPI:1417386236
Name:TRI- ELIZABETH HIMES
Entity Type:Organization
Organization Name:TRI- ELIZABETH HIMES
Other - Org Name:TRI-ELIZABETH HOMES 1/ SAN PABLO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PRESCILA
Authorized Official - Middle Name:S
Authorized Official - Last Name:BARRIOS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:714-296-5135
Mailing Address - Street 1:6962 SAN PACO CIR
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90620-2964
Mailing Address - Country:US
Mailing Address - Phone:714-220-2185
Mailing Address - Fax:714-826-0296
Practice Address - Street 1:8341 SAN PABLO DR
Practice Address - Street 2:
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90620-2919
Practice Address - Country:US
Practice Address - Phone:714-220-2185
Practice Address - Fax:714-826-0296
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-02
Last Update Date:2013-11-02
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