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General NPI Number Information
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NPI Number | 1568905958
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Entity Type | Organization
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Legal Business Name | ANGELS MANOR CARE HOME
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Dates
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Enumeration Date | 12/02/2016
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Last Update Date | 12/02/2016
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Provider Practice Location Address
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Address Line | 1021 HEATHERFIELD LN
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City | SAN JOSE
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State | CA
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Zip | 95132-2931
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Country | US
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Telephone | 408-272-8655
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Fax | 408-258-1328
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Provider Business Mailing Address
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Address Line | 1021 HEATHERFIELD LN
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City | SAN JOSE
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State | CA
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Zip | 95132-2931
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Country | US
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Telephone | 408-272-8655
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Fax | 408-258-1328
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Authorized Official
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Title or Position | LINCESEE ADMINISTRATOR
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Name | ELMA L FERNANDEZ
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Credential |
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Telephone | 408-272-8655
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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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