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General NPI Number Information
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NPI Number | 1003208281
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Entity Type | Organization
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Legal Business Name | BAY HORIZON ICF-DDH
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Dates
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Enumeration Date | 02/25/2015
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Last Update Date | 02/25/2015
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Provider Practice Location Address
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Address Line | 516 OCEAN VIEW AVE
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City | SAN MATEO
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State | CA
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Zip | 94401-3029
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Country | US
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Telephone | 650-347-1164
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Fax | 650-348-2795
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Provider Business Mailing Address
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Address Line | 1565 ROYAL AVE
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City | SAN MATEO
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State | CA
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Zip | 94401-3432
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Country | US
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Telephone | 650-347-1164
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Fax | 650-348-2795
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Authorized Official
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Title or Position | CEO
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Name | MISS PUREZA AGUZAR GANIO
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Credential |
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Telephone | 650-520-5545
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number | 220000319
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License Number State | CA
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