Provider Demographics
NPI:1912342650
Name:THERAPEUTIC CHILD CARE CENTER
Entity Type:Organization
Organization Name:THERAPEUTIC CHILD CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:K
Authorized Official - Last Name:HIMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-253-4279
Mailing Address - Street 1:2751 NAPA VALLEY CORPORATE DR
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-6216
Mailing Address - Country:US
Mailing Address - Phone:707-253-6099
Mailing Address - Fax:
Practice Address - Street 1:2751 NAPA VALLEY CORPORATE DR
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-6216
Practice Address - Country:US
Practice Address - Phone:707-253-6099
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NAPA COUNTY HEALTH AND HUMAN SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-05-08
Last Update Date:2018-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
BU669ZOtherMEDICARE
CA2800028Medicaid