Provider Demographics
NPI:1700089554
Name:PRIMER PASO INSTITUTE INC
Entity Type:Organization
Organization Name:PRIMER PASO INSTITUTE INC
Other - Org Name:ANGELA'S HOUSE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RICARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:VASQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-734-6042
Mailing Address - Street 1:310 N CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-5009
Mailing Address - Country:US
Mailing Address - Phone:559-734-6042
Mailing Address - Fax:559-635-4788
Practice Address - Street 1:1300 S CROWE ST
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93277-2106
Practice Address - Country:US
Practice Address - Phone:559-734-5480
Practice Address - Fax:559-734-5783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA545402Medicaid