| Organization Name: | JERIDA LANE RESIDENTIAL CARE |
| NPI Number: | 1154585883 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ESTRELLITA DE MESA OLEA (LICENSEE/ADMINISTRATOR) |
| Mailing Address: | 8830 Jerida Ln Fair Oaks |
| State: | CA US |
| Postal Code: | 956285470 |
| Phone Number: | 9166068241 |
| Fax Number: | 9168630668 |
| NPI Enumeration Date: | 07/11/2008 |
| NPI Last Update Date: | 07/11/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 320700000X |
| License Number: | 347003312 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Residential Treatment Facilities |
| Taxonomy Classification: | Residential Treatment Facility, Physical Disabilities |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A residential facility that provides habilitation services and other care and treatment to adults or children diagnosed with developmental disabilities and/or mental retardation and are not able to live independently. |