Healthcare Provider Details

I. General information

NPI: 1356480545
Provider Name (Legal Business Name): JILL LEE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 08/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2740 CALIFORNIA ST NONE
SAN FRANCISCO CA
94115-2514
US

IV. Provider business mailing address

2740 CALIFORNIA ST NONE
SAN FRANCISCO CA
94115-2514
US

V. Phone/Fax

Practice location:
  • Phone: 415-567-3133
  • Fax: 415-567-0250
Mailing address:
  • Phone: 415-567-3133
  • Fax: 415-567-0250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number220000109
License Number StateCA

VIII. Authorized Official

Name: MS. JILL NONE LEE
Title or Position: ADMINISTRATOR
Credential: NURSING HOME ADM.
Phone: 415-567-3133