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General NPI Number Information
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NPI Number | 1912423203
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Entity Type | Organization
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Legal Business Name | LADWIG INC
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Dates
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Enumeration Date | 08/17/2017
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Last Update Date | 08/17/2017
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Provider Practice Location Address
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Address Line | 683 UNDAJON DR
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City | SAN JOSE
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State | CA
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Zip | 95133-1736
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Country | US
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Telephone | 408-937-1542
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Fax |
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Provider Business Mailing Address
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Address Line | 3340 PINKERTON DR
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City | SAN JOSE
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State | CA
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Zip | 95148-2753
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Country | US
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Telephone | 408-821-2630
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR/LICENSEE
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Name | JUVELYN IRISH LADWIG
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Credential |
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Telephone | 408-821-2630
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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 | 435202568
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License Number State | CA
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