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General NPI Number Information
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NPI Number | 1083004782
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Entity Type | Organization
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Legal Business Name | STEPHANIE HOME INC.
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Dates
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Enumeration Date | 02/02/2015
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Last Update Date | 02/02/2015
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Provider Practice Location Address
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Address Line | 776 DEL MONTE AVE
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City | SOUTH SAN FRANCISCO
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State | CA
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Zip | 94080-2230
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Country | US
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Telephone | 650-757-7115
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Fax | 650-991-3979
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Provider Business Mailing Address
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Address Line | 2893 EL CAMINO REAL STE C
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City | REDWOOD CITY
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State | CA
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Zip | 94061-4039
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Country | US
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Telephone | 650-216-9960
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Fax | 650-216-9455
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Authorized Official
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Title or Position | PRESIDENT
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Name | DEYRA SUNGA
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Credential | RN
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Telephone | 650-892-4572
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 315P00000X
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Taxonomy Name | Intellectual Disabilities Intermediate Care Facility
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License Number |
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License Number State | CA
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Taxonomy #2
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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 | CA
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