Provider Demographics
NPI:1609195221
Name:PSB HOMES, INC
Entity Type:Organization
Organization Name:PSB HOMES, INC
Other - Org Name:CASA DE YORBA LINDA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PRISCILLA
Authorized Official - Middle Name:S
Authorized Official - Last Name:BUSTAMANTE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-926-2352
Mailing Address - Street 1:20065 VIA NATALIE
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92887-3151
Mailing Address - Country:US
Mailing Address - Phone:714-926-2352
Mailing Address - Fax:
Practice Address - Street 1:4742 VIA DEL RANCHO
Practice Address - Street 2:
Practice Address - City:YORBA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92886-2927
Practice Address - Country:US
Practice Address - Phone:714-777-5130
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-21
Last Update Date:2010-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55G297315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities