Provider Demographics
NPI:1699943654
Name:MOTHER CYNTHIA'S RESIDENTIAL CARE FACILITY
Entity type:Organization
Organization Name:MOTHER CYNTHIA'S RESIDENTIAL CARE FACILITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LISCENSEE/ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BUNTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-357-0613
Mailing Address - Street 1:P.O. BOX 1554
Mailing Address - Street 2:
Mailing Address - City:ATWATER
Mailing Address - State:CA
Mailing Address - Zip Code:95301
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:209-357-8249
Practice Address - Street 1:1680 SHAFFER RD
Practice Address - Street 2:
Practice Address - City:ATWATER
Practice Address - State:CA
Practice Address - Zip Code:95301-4448
Practice Address - Country:US
Practice Address - Phone:209-357-0613
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-13
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA247204044261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health