MEDICARE: ST. ANNE'S HOME

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
1	314000000X	Skilled Nursing Facility		CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1700873957
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST. ANNE'S HOME

Provider Business Mailing Address
First Line	:	300 LAKE ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94118-1357
Country	:	US
Telephone Number	:	415-751-6510
Fax Number	:	415-751-1423

Provider Business Practice Location Address
First Line	:	300 LAKE ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94118-1357
Country	:	US
Telephone Number	:	415-751-6510
Fax Number	:	415-751-1423

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	SISTER ANTHONY SELEWICZ
Credential	:	NHA
Telephone Number	:	415-751-6510

Provider Enumeration Date	:	10/03/2005
Last Update Date	:	08/22/2020

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