Healthcare Provider Details

I. General information

NPI: 1366637357
Provider Name (Legal Business Name): OBDULIA'S RESTHOME, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2007
Last Update Date: 09/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2335 SILVER AVE 1919 PALOU AVE
SAN FRANCISCO CA
94124-2060
US

IV. Provider business mailing address

PO BOX 883542
SAN FRANCISCO CA
94188-3542
US

V. Phone/Fax

Practice location:
  • Phone: 415-641-4171
  • Fax: 415-821-0720
Mailing address:
  • Phone: 415-641-4171
  • Fax: 415-821-0720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number StateCA

VIII. Authorized Official

Name: ROSE CAREY
Title or Position: LICENSEE/ADMINISTRATOR
Credential:
Phone: 415-641-4171