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General NPI Number Information
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NPI Number | 1841330065
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Entity Type | Organization
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Legal Business Name | REDENCION A LELCHUK
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Dates
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Enumeration Date | 02/07/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 27495 BAHAMA AVENUE
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City | HAYWARD
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State | CA
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Zip | 94545
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Country | US
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Telephone | 510-670-0207
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Fax | 510-732-9103
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Provider Business Mailing Address
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Address Line | 2691 BEACHWOOD STREET
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City | HAYWARD
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State | CA
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Zip | 94545
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Country | US
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Telephone | 510-670-0207
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Fax | 510-732-9103
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Authorized Official
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Title or Position | OWNER ADMINISTRATOR
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Name | MRS. REDENCION ALINAS LELCHUK
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Credential |
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Telephone | 510-887-6677
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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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