Provider Demographics
NPI:1336290014
Name:LAGUNA ICF, INC.
Entity Type:Organization
Organization Name:LAGUNA ICF, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:FELIPE
Authorized Official - Middle Name:TAPANGCO
Authorized Official - Last Name:LAPASTORA
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:209-836-5561
Mailing Address - Street 1:294 LAGUNA DR
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95376-1930
Mailing Address - Country:US
Mailing Address - Phone:209-836-5561
Mailing Address - Fax:209-832-5990
Practice Address - Street 1:294 LAGUNA DR
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95376-1930
Practice Address - Country:US
Practice Address - Phone:209-836-5561
Practice Address - Fax:209-832-5990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2023-09-06
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