Provider Demographics
NPI:1689753444
Name:MIDOMAR HOMES INC.
Entity Type:Organization
Organization Name:MIDOMAR HOMES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ADORACION
Authorized Official - Middle Name:MANALAD
Authorized Official - Last Name:PALISOC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-974-4321
Mailing Address - Street 1:17807 BELSHIRE AVE
Mailing Address - Street 2:
Mailing Address - City:ARTESIA
Mailing Address - State:CA
Mailing Address - Zip Code:90701-4234
Mailing Address - Country:US
Mailing Address - Phone:562-865-3337
Mailing Address - Fax:562-865-3337
Practice Address - Street 1:17807 BELSHIRE AVE
Practice Address - Street 2:
Practice Address - City:ARTESIA
Practice Address - State:CA
Practice Address - Zip Code:90701-4234
Practice Address - Country:US
Practice Address - Phone:562-865-3337
Practice Address - Fax:562-865-3337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2020-08-22
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