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General NPI Number Information
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NPI Number | 1972069763
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Entity Type | Organization
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Legal Business Name | AMD ALTERNATIVE CARE SERVICES
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Dates
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Enumeration Date | 02/16/2019
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Last Update Date | 02/16/2019
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Provider Practice Location Address
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Address Line | 3939 MEADOWBROOK CIR
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City | PITTSBURG
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State | CA
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Zip | 94565-5539
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Country | US
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Telephone | 925-431-0415
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Fax |
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Provider Business Mailing Address
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Address Line | 278 CERRO DR
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City | DALY CITY
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State | CA
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Zip | 94015-4083
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Country | US
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Telephone | 650-296-9425
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Fax | 650-758-4732
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Authorized Official
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Title or Position | ADMINISTRATOR/OWNER
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Name | AMY DAWANA BUCCAT
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Credential | RN
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Telephone | 650-296-9425
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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 |
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