Provider Demographics
NPI:1689003733
Name:TRI-ELIZABETH HOMES
Entity Type:Organization
Organization Name:TRI-ELIZABETH HOMES
Other - Org Name:TRI-ELIZABETH HOMES/VAN BUREN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PRESCILA
Authorized Official - Middle Name:S
Authorized Official - Last Name:BARRIOS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:714-296-5135
Mailing Address - Street 1:6962 SAN PACO CIR
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90620-2964
Mailing Address - Country:US
Mailing Address - Phone:714-828-4809
Mailing Address - Fax:714-826-0296
Practice Address - Street 1:7036 VAN BUREN WAY
Practice Address - Street 2:
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90620-3832
Practice Address - Country:US
Practice Address - Phone:714-828-4809
Practice Address - Fax:714-826-0296
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-08
Last Update Date:2013-11-08
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