Provider Demographics
NPI:1629079272
Name:SPECIALIZED DAYCARE SERVICES, INC
Entity Type:Organization
Organization Name:SPECIALIZED DAYCARE SERVICES, INC
Other - Org Name:MY FRIENDS PEDIATRIC DAY HEALTHCARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:GIACHINO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:916-987-8632
Mailing Address - Street 1:PO BOX 1111
Mailing Address - Street 2:
Mailing Address - City:FAIR OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:95628-1111
Mailing Address - Country:US
Mailing Address - Phone:916-987-8632
Mailing Address - Fax:916-989-8635
Practice Address - Street 1:4811 LAGUNA BLVD
Practice Address - Street 2:SUITE 120
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95758-7043
Practice Address - Country:US
Practice Address - Phone:916-987-8632
Practice Address - Fax:916-989-8635
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SPECIALIZED DAYCARE SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-08-04
Last Update Date:2017-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
343900000X
CA1000001804385HR2065X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2065XRespite Care FacilityRespite CareRespite Care, Physical Disabilities, Child
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1629079272Medicaid