Provider Demographics
NPI:1952617870
Name:SANTA LUCIA II ICF-DDH
Entity type:Organization
Organization Name:SANTA LUCIA II ICF-DDH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LEONILA
Authorized Official - Middle Name:REALEZA
Authorized Official - Last Name:PADILLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-655-3225
Mailing Address - Street 1:722 LASSEN ST
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94591-5467
Mailing Address - Country:US
Mailing Address - Phone:707-554-1975
Mailing Address - Fax:707-648-1549
Practice Address - Street 1:722 LASSEN ST
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94591-5467
Practice Address - Country:US
Practice Address - Phone:707-554-1975
Practice Address - Fax:707-648-1549
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-30
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310500000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Mental Illness