Provider Demographics
NPI:1477735892
Name:EEC BALTAZAR CORPORATION
Entity Type:Organization
Organization Name:EEC BALTAZAR CORPORATION
Other - Org Name:ST. PATRICK'S GOLDEN CARE RANCH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:EDUARDO
Authorized Official - Middle Name:PASCUA
Authorized Official - Last Name:BALTAZAR
Authorized Official - Suffix:JR
Authorized Official - Credentials:RN
Authorized Official - Phone:916-988-0157
Mailing Address - Street 1:7104 SANTA JUANITA AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGEVALE
Mailing Address - State:CA
Mailing Address - Zip Code:95662-2832
Mailing Address - Country:US
Mailing Address - Phone:916-988-0157
Mailing Address - Fax:916-988-0884
Practice Address - Street 1:7104 SANTA JUANITA AVE
Practice Address - Street 2:
Practice Address - City:ORANGEVALE
Practice Address - State:CA
Practice Address - Zip Code:95662-2832
Practice Address - Country:US
Practice Address - Phone:916-988-0157
Practice Address - Fax:916-988-0884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-27
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA311500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARCF00035FOtherMEDICAL