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Sunshine Icf Ddn
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Lodi, California
NPI 1437473063

Sunshine Icf Ddn is a Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility based in Lodi, CA. Sunshine Icf Ddn practices in Lodi, CA. The NPI Number for Sunshine Icf Ddn is 1437473063 and holds a License No. 55GP1907 (California).

The current practice location address for Sunshine Icf Ddn is 1701 W Elm St, Lodi, CA and can be reached out via phone at 209-598-1436.

Location: 1701 W Elm St, Lodi, CA, 95242-2916
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1437473063
Provider Name
Sunshine Icf Ddn
Credential
Provider Entity Type
Organization
Address
1701 W Elm St, Lodi, CA, 95242-2916
Phone Number
209-598-1436
Fax Number
Provider Enumeration Date
03/25/2010
Last Update Date
03/09/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
55GP1907 01 CA MEDI-CAL PROVIDER
institution
Provider Business Practice Location Address Details
Address
1701 W Elm St
City
Lodi
State
California
Zip
95242-2916
Phone Number
209-598-1436
Fax Number
person
Provider Business Mailing Address Details
Address
1701 W Elm St
City
Lodi
State
California
Zip
95242-2916
Phone Number
209-598-1436
Fax Number
person
Provider's Taxonomy Details 1
Type
Residential Treatment Facilities
Classification
Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Speciality
-
Taxonomy
320900000X
License No.
55GP1907 (California)
Definition
A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with intellectual and/or developmental disabilities.
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