Healthcare Provider Details

I. General information

NPI: 1497675268
Provider Name (Legal Business Name): ROSE GUEST HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1820 BETHANY AVE
SAN JOSE CA
95132-1514
US

IV. Provider business mailing address

1820 BETHANY AVE
SAN JOSE CA
95132-1514
US

V. Phone/Fax

Practice location:
  • Phone: 650-892-3936
  • Fax: 408-649-6532
Mailing address:
  • Phone: 650-892-3936
  • Fax: 408-649-6532

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: LILIAN CANLAS SACUN
Title or Position: ADMINISTRATOR
Credential: LICENSEE
Phone: 650-892-3936