Healthcare Provider Details

I. General information

NPI: 1538159769
Provider Name (Legal Business Name): MARGUERITE TERRACE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 KIRK AVE
SAN JOSE CA
95127-2214
US

IV. Provider business mailing address

10 KIRK AVE
SAN JOSE CA
95127-2214
US

V. Phone/Fax

Practice location:
  • Phone: 408-729-2000
  • Fax:
Mailing address:
  • Phone: 408-729-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MS. LORI MICHELLE APPLEBEE
Title or Position: DIRECTOR OF NURSING
Credential: RN
Phone: 408-729-2010