Healthcare Provider Details

I. General information

NPI: 1760701486
Provider Name (Legal Business Name): LYRICETE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2010
Last Update Date: 05/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

279 TEDDY AVE APT A
SAN FRANCISCO CA
94134-2339
US

IV. Provider business mailing address

279 TEDDY AVE APT A
SAN FRANCISCO CA
94134-2339
US

V. Phone/Fax

Practice location:
  • Phone: 800-695-1106
  • Fax: 800-695-1106
Mailing address:
  • Phone: 800-695-1106
  • Fax: 800-695-1106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberVN192915
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License NumberVN192915
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License NumberC5720996
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License NumberVN192915
License Number StateCA

VIII. Authorized Official

Name: TIANA DANIELLE BLUNT
Title or Position: CEO
Credential: LVN
Phone: 415-410-1985