Healthcare Provider Details

I. General information

NPI: 1659203719
Provider Name (Legal Business Name): ODD FELLOW-REBEKAH CHILDREN'S HOME OF CALIFORNIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7121 GRENACHE WAY
GILROY CA
95020-2500
US

IV. Provider business mailing address

290 IOOF AVE
GILROY CA
95020-5204
US

V. Phone/Fax

Practice location:
  • Phone: 408-846-2100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER DANG MALONE
Title or Position: CHIEF COMPLIANCE OFFICER
Credential:
Phone: 408-591-0043