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General NPI Number Information
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NPI Number | 1497040117
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Entity Type | Organization
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Legal Business Name | HILLSBOROUGH MANOR INC.
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Dates
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Enumeration Date | 06/10/2011
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Last Update Date | 06/10/2011
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Provider Practice Location Address
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Address Line | 1776 ADAMS ST
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City | SAN MATEO
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State | CA
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Zip | 94403-1108
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Country | US
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Telephone | 650-578-1091
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Fax | 650-216-9455
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Provider Business Mailing Address
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Address Line | 2893 EL CAMINO REAL, STE. C
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City | REDWOOD CITY
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State | CA
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Zip | 94061
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Country | US
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Telephone | 650-216-9960
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Fax | 650-216-9455
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. ROSEMARIE TAMBOT VERIDIANO
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Credential | PHARMACIST
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Telephone | 650-580-2983
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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 | 315P00000X
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License Number State | CA
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