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General NPI Number Information
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NPI Number | 1154714616
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Entity Type | Organization
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Legal Business Name | LESTERS HOME INC.
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Dates
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Enumeration Date | 03/09/2015
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Last Update Date | 03/09/2015
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Provider Practice Location Address
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Address Line | 3271 SUSAN DR
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City | SAN BRUNO
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State | CA
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Zip | 94066-1639
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Country | US
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Telephone | 650-359-7865
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Fax | 650-359-7865
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Provider Business Mailing Address
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Address Line | 3271 SUSAN DR
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City | SAN BRUNO
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State | CA
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Zip | 94066-1639
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Country | US
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Telephone | 650-359-7865
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Fax | 650-359-7865
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Authorized Official
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Title or Position | QIDP
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Name | MR. LOUIE BARANGAN
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Credential |
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Telephone | 650-388-2507
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number | 220000483
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License Number State | CA
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