Provider Demographics
NPI:1609033588
Name:PTL PEDIATRIC DAYCARE
Entity Type:Organization
Organization Name:PTL PEDIATRIC DAYCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:D
Authorized Official - Last Name:BURNS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:530-343-8344
Mailing Address - Street 1:1890 BEDFORD DR
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95928-7352
Mailing Address - Country:US
Mailing Address - Phone:530-343-8344
Mailing Address - Fax:530-343-6683
Practice Address - Street 1:1890 BEDFORD DR
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95928-7352
Practice Address - Country:US
Practice Address - Phone:530-343-8344
Practice Address - Fax:530-343-6683
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-19
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA550000327385HR2060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAEPSP00130Medicaid