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General NPI Number Information
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NPI Number | 1427255827
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Entity Type | Organization
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Legal Business Name | STA INES CARE HOME INC
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Dates
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Enumeration Date | 06/29/2007
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Last Update Date | 07/19/2007
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Provider Practice Location Address
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Address Line | 1644 YORKTOWN RD
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City | SAN MATEO
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State | CA
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Zip | 94402-4038
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Country | US
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Telephone | 650-759-8518
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Fax |
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Provider Business Mailing Address
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Address Line | 1644 YORKTOWN RD
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City | SAN MATEO
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State | CA
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Zip | 94402-4038
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Country | US
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Telephone | 650-759-8518
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Fax |
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Authorized Official
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Title or Position | OWNER ADMINISTRATOR
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Name | LEONILA REYES SALOMON
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Credential |
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Telephone | 650-759-8518
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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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