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NPI Code Detail

MEDICARE: SERVICE LEAGUE OF SAN MATEO COUNTY

MEDICARE: SERVICE LEAGUE OF SAN MATEO COUNTY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1324500000XSubstance Abuse Rehabilitation Facility410013ANCA

General Provider Information

NPI Number : 1518253020
Entity Type Code : Organization
Provider Name (Legal Business Name) : SERVICE LEAGUE OF SAN MATEO COUNTY
Provider Business Mailing Address
First Line : 727 MIDDLEFIELD ROAD
Second Line :
City : REDWOOD CITY
State : CA
Zip : 94063-4504
Country : US
Telephone Number : 650-364-4664
Fax Number : 650-365-6817
Provider Business Practice Location Address
First Line : 3789 HOOVER ST
Second Line :
City : REDWOOD CITY
State : CA
Zip : 94063-4504
Country : US
Telephone Number : 650-363-8735
Fax Number : 650-363-8701
Authorized Official
Title or Position : DIRECTOR
Name : KAREN MARIE FRANCONE
Credential : CADAC II
Telephone Number : 650-364-4664
Provider Enumeration Date : 06/22/2011
Last Update Date : 05/02/2014

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Directions to “SERVICE LEAGUE OF SAN MATEO COUNTY ” Practice Location

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