Healthcare Provider Details

I. General information

NPI: 1396964722
Provider Name (Legal Business Name): SAN FRANCISCO LADIES PROTECTION AND RELIEF SOCIETY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 04/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 LAGUNA ST
SAN FRANCISCO CA
94123-2271
US

IV. Provider business mailing address

3400 LAGUNA ST
SAN FRANCISCO CA
94123-2271
US

V. Phone/Fax

Practice location:
  • Phone: 415-202-0300
  • Fax: 415-292-7080
Mailing address:
  • Phone: 415-202-0300
  • Fax: 415-292-7080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number220000034
License Number StateCA

VIII. Authorized Official

Name: MR. KEN D DONNELLY
Title or Position: CEO
Credential:
Phone: 415-202-0343