Provider Demographics
NPI:1578749149
Name:PEEBLES FAMILY CARE HOME
Entity Type:Organization
Organization Name:PEEBLES FAMILY CARE HOME
Other - Org Name:PALS ASSISTED LIVING SERVICES INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:NAWANA
Authorized Official - Middle Name:MIESA
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-298-0849
Mailing Address - Street 1:404 NORTH BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95205
Mailing Address - Country:US
Mailing Address - Phone:209-464-3024
Mailing Address - Fax:209-944-5659
Practice Address - Street 1:404 NORTH BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95205
Practice Address - Country:US
Practice Address - Phone:209-464-3024
Practice Address - Fax:209-944-5659
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-14
Last Update Date:2008-01-14
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