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General NPI Number Information
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NPI Number | 1407390875
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Entity Type | Organization
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Legal Business Name | SAINT ANTHONY'S CARE HOME FOR THE ELDERLY
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Dates
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Enumeration Date | 12/05/2016
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Last Update Date | 12/05/2016
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Provider Practice Location Address
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Address Line | 3258 EVCO CT
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City | SAN JOSE
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State | CA
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Zip | 95127-1502
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Country | US
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Telephone | 408-708-4164
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Fax |
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Provider Business Mailing Address
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Address Line | 3258 EVCO CT
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City | SAN JOSE
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State | CA
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Zip | 95127-1502
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Country | US
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Telephone | 408-708-4164
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | EUGENE JAVIER CASTILLEJO
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Credential | LVN
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Telephone | 408-478-1288
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 435294209
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License Number State | CA
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