Provider Demographics
NPI:1700068111
Name:BUTLER VALLEY # 2
Entity Type:Organization
Organization Name:BUTLER VALLEY # 2
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SUZETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:OTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-442-2451
Mailing Address - Street 1:5245 VANCE ST
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95503-6350
Mailing Address - Country:US
Mailing Address - Phone:707-442-2451
Mailing Address - Fax:707-445-1887
Practice Address - Street 1:3971 F ST
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95503-6003
Practice Address - Country:US
Practice Address - Phone:707-442-7313
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BUTLER VALLEY INCORPORATED
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-11-28
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALTC60133F315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities