Marcies Manor III Icf

Primary specialty

Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X

License

100000773 Issued in CA

Legal business name

MARCIES MANOR III ICF

Practice address

1528 Venetian Dr
Stockton, CA 95207-5422

Phone

(209) 952-6122

Fax

(209) 478-3391

NPI assigned

Feb 3, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Marcie H. Patubo

Title

Owner

Phone

(209) 478-3391

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170460800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1209513600000",
    "number": "1932247541",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5450 SAINT ANDREWS DR",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952191918",
            "telephone_number": "209-478-3391",
            "fax_number": "209-478-3391"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1528 VENETIAN DR",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952075422",
            "telephone_number": "209-952-6122",
            "fax_number": "209-478-3391"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARCIES MANOR III ICF",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-03",
        "last_updated": "2008-04-30",
        "status": "A",
        "authorized_official_last_name": "PATUBO",
        "authorized_official_first_name": "MARCIE",
        "authorized_official_middle_name": "H.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "209-478-3391"
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "CA",
            "license": "100000773",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "LTC61051F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Eugene F. Marcelo, BS
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• March Lane Pediatric Group
• March Therapeutics LLC
• March Therapeutics LLC
• May Mardini, PT
• Gamal Mohamed Khalil Marey, M.D.
• Lisa Marie Marglin, LPT
• Erika Maria Maria Garcia
• Maria Theresa G. Oronce

• Intellectual and/or Developmental Disabilities Residential Treatment Facility in Stockton, CA
• Providers in Stockton, CA by specialty
• Intellectual and/or Developmental Disabilities Residential Treatment Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.