Healthcare Provider Details

I. General information

NPI: 1720869951
Provider Name (Legal Business Name): FAMILY AFFAIR CARE HOME,INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2023
Last Update Date: 03/28/2024
Certification Date: 03/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 COLLEGE DR # 94066
SAN BRUNO CA
94066-1609
US

IV. Provider business mailing address

3100 COLLEGE DR
SAN BRUNO CA
94066-1609
US

V. Phone/Fax

Practice location:
  • Phone: 415-672-1599
  • Fax: 650-729-1012
Mailing address:
  • Phone: 415-672-1599
  • Fax: 650-729-1012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: HUI C LESLIE
Title or Position: PRESIDENT
Credential:
Phone: 415-672-1599