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General NPI Number Information
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NPI Number | 1013194497
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Entity Type | Organization
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Legal Business Name | AMERICAN STAR HOME 3 ICF/DD-N
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Dates
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Enumeration Date | 01/28/2008
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Last Update Date | 02/24/2024
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Provider Practice Location Address
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Address Line | 125 BROWNSTONE ROAD
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City | OAKLEY
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State | CA
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Zip | 94561-5900
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Country | US
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Telephone | 925-625-7354
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Fax | 925-625-7384
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Provider Business Mailing Address
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Address Line | 2009 FITZGERALD WAY
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City | BRENTWOOD
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State | CA
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Zip | 94513
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Country | US
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Telephone | 925-813-1979
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Fax | 925-420-6748
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Authorized Official
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Title or Position | PRESIDENT/ADMINISTRATOR/OWNER
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Name | MRS. VICKY SANTOS TING
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Credential | BSN
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Telephone | 925-813-1979
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number |
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License Number State |
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