Healthcare Provider Details

I. General information

NPI: 1881632347
Provider Name (Legal Business Name): LYTTON GARDENS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 01/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

437 WEBSTER STREET
PALO ALTO CA
94301-1242
US

IV. Provider business mailing address

437 WEBSTER STREET
PALO ALTO CA
94301-1242
US

V. Phone/Fax

Practice location:
  • Phone: 650-328-3300
  • Fax: 650-617-7332
Mailing address:
  • Phone: 650-328-3300
  • Fax: 650-617-7332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number220000434
License Number StateCA

VIII. Authorized Official

Name: JONATHAN F CASEY
Title or Position: CFO
Credential:
Phone: 650-617-7312