Provider Demographics
NPI:1336445212
Name:PTL PEDIATRIC DAYCARE CENTERS INC
Entity Type:Organization
Organization Name:PTL PEDIATRIC DAYCARE CENTERS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-891-0657
Mailing Address - Street 1:PO BOX 3726
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95927-3726
Mailing Address - Country:US
Mailing Address - Phone:530-891-0657
Mailing Address - Fax:530-891-8853
Practice Address - Street 1:1890 BEDFORD DR
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95928-7352
Practice Address - Country:US
Practice Address - Phone:530-343-8344
Practice Address - Fax:530-343-6683
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-09
Last Update Date:2011-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA550000327385HR2065X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2065XRespite Care FacilityRespite CareRespite Care, Physical Disabilities, Child
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA550000327OtherCA MEDI-CAL