Healthcare Provider Details

I. General information

NPI: 1023408929
Provider Name (Legal Business Name): ADAMS ICF/DD-N
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2015
Last Update Date: 01/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1778 ADAMS ST
SAN MATEO CA
94403-1108
US

IV. Provider business mailing address

2893 EL CAMINO REAL STE C
REDWOOD CITY CA
94061-4039
US

V. Phone/Fax

Practice location:
  • Phone: 650-522-8101
  • Fax: 650-525-0411
Mailing address:
  • Phone: 650-216-9960
  • Fax: 650-216-9455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number
License Number State

VIII. Authorized Official

Name: DEYRA SUNGA
Title or Position: PRESIDENT
Credential: RN
Phone: 650-892-4572