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General NPI Number Information
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NPI Number | 1477354223
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Entity Type | Organization
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Legal Business Name | ST JOSPEHS HOME
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Dates
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Enumeration Date | 03/19/2025
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Last Update Date | 03/19/2025
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Provider Practice Location Address
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Address Line | 2496 1/2 N MACY ST
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City | SAN BERNARDINO
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State | CA
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Zip | 92407-6597
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Country | US
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Telephone | 786-564-3771
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Fax | 909-408-8027
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Provider Business Mailing Address
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Address Line | 2496 1/2 N MACY ST
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City | SAN BERNARDINO
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State | CA
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Zip | 92407-6597
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Country | US
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Telephone | 786-564-3771
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Fax | 909-408-8027
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Authorized Official
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Title or Position | OWNER
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Name | EBRAHEEM H HAMED
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Credential |
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Telephone | 786-564-3771
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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 |
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License Number State |
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