Healthcare Provider Details

I. General information

NPI: 1104011097
Provider Name (Legal Business Name): VEALS RESIDENTIAL CARE HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2007
Last Update Date: 09/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 LOBOS STREET
SAN FRANCISCO CA
94112
US

IV. Provider business mailing address

69 LOBOS STREET
SAN FRANSISCO CA
94112
US

V. Phone/Fax

Practice location:
  • Phone: 415-333-3816
  • Fax: 415-585-1854
Mailing address:
  • Phone: 415-333-3816
  • Fax: 415-585-1854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MS. KEIKO KANEZAKI
Title or Position: OWNER ADMINISTRATOR
Credential:
Phone: 415-333-3816