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General NPI Number Information
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NPI Number | 1164081089
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Entity Type | Organization
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Legal Business Name | ANTON'S HOME, INC.
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Dates
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Enumeration Date | 06/13/2019
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Last Update Date | 06/13/2019
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Provider Practice Location Address
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Address Line | 2598 OLYMPIC DRIVE,
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City | SAN BRUNO
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State | CA
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Zip | 94066-1251
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Country | US
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Telephone | 650-553-5009
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Fax | 850-878-3131
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Provider Business Mailing Address
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Address Line | 4358 CALLAN BLVD.
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City | DALY CITY
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State | CA
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Zip | 94015-4404
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Country | US
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Telephone | 415-987-3401
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Fax | 650-878-3131
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. ESTELITA SANTIAGO EVANGELISTA
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Credential |
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Telephone | 415-987-3401
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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 |
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