Provider Demographics
NPI:1568650927
Name:REIMS ICFDD-H
Entity type:Organization
Organization Name:REIMS ICFDD-H
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSEE
Authorized Official - Prefix:MR
Authorized Official - First Name:DOMINADOR
Authorized Official - Middle Name:DELACRUZ
Authorized Official - Last Name:PAJARITO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-366-2119
Mailing Address - Street 1:22801 N SOWLES RD
Mailing Address - Street 2:
Mailing Address - City:ACAMPO
Mailing Address - State:CA
Mailing Address - Zip Code:95220-9608
Mailing Address - Country:US
Mailing Address - Phone:209-366-2119
Mailing Address - Fax:209-366-2119
Practice Address - Street 1:22801 N SOWLES RD
Practice Address - Street 2:
Practice Address - City:ACAMPO
Practice Address - State:CA
Practice Address - Zip Code:95220-9608
Practice Address - Country:US
Practice Address - Phone:209-366-2119
Practice Address - Fax:209-366-2119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-11
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities