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General NPI Number Information
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NPI Number | 1558702431
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Entity Type | Organization
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Legal Business Name | HONEYNUT HAVEN RCFE
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Dates
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Enumeration Date | 07/09/2013
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Last Update Date | 07/09/2013
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Provider Practice Location Address
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Address Line | 2900 HONEYNUT ST
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City | ANTIOCH
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State | CA
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Zip | 94509-7349
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Country | US
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Telephone | 925-776-4849
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Fax |
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Provider Business Mailing Address
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Address Line | 2900 HONEYNUT ST
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City | ANTIOCH
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State | CA
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Zip | 94509-7349
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO/ADMINISTRATOR
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Name | YVONNE R CARTER
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Credential |
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Telephone | 925-776-4849
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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 | 079200289
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License Number State | CA
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