Provider Demographics
NPI:1982034898
Name:VILLA DE MARTIN JUDE HOMES ARCHER 2
Entity Type:Organization
Organization Name:VILLA DE MARTIN JUDE HOMES ARCHER 2
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINSTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RAMON
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-746-4294
Mailing Address - Street 1:320 S ARCHER ST
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92804-2418
Mailing Address - Country:US
Mailing Address - Phone:714-776-7610
Mailing Address - Fax:714-242-9195
Practice Address - Street 1:320 S ARCHER ST
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92804-2418
Practice Address - Country:US
Practice Address - Phone:714-776-7610
Practice Address - Fax:714-242-9195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-14
Last Update Date:2013-11-14
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