Healthcare Provider Details

I. General information

NPI: 1083004782
Provider Name (Legal Business Name): STEPHANIE HOME INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2015
Last Update Date: 02/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

776 DEL MONTE AVE
SOUTH SAN FRANCISCO CA
94080-2230
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 650-757-7115
  • Fax: 650-991-3979
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 StateCA
# 2
Primary TaxonomyN
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number
License Number StateCA

VIII. Authorized Official

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