Healthcare Provider Details

I. General information

NPI: 1295151710
Provider Name (Legal Business Name): ZUHA HOMES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2014
Last Update Date: 03/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13881 COBBLESTONE CT
FONTANA CA
92335-0504
US

IV. Provider business mailing address

13881 COBBLESTONE CT
FONTANA CA
92335-0504
US

V. Phone/Fax

Practice location:
  • Phone: 909-258-6349
  • Fax: 909-874-6711
Mailing address:
  • Phone: 909-258-6349
  • Fax: 909-874-6711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number StateCA

VIII. Authorized Official

Name: SRIADI SUTJININGSIH
Title or Position: VICE PRESIDENT
Credential:
Phone: 909-258-6349