MEDICARE: B & M INC. - FLEETWOOD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	315P00000X	Intellectual Disabilities Intermediate Care Facility		CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013131671
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	B & M INC. - FLEETWOOD

Provider Business Mailing Address
First Line	:	52 POINTE VIEW PL
Second Line	:
City	:	SOUTH SAN FRANCISCO
State	:	CA
Zip	:	94080-1673
Country	:	US
Telephone Number	:	650-273-8181
Fax Number	:	650-359-7865

Provider Business Practice Location Address
First Line	:	2796 FLEETWOOD DR
Second Line	:
City	:	SAN BRUNO
State	:	CA
Zip	:	94066-2627
Country	:	US
Telephone Number	:	650-273-8181
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT CEO
Name	:	MS. MARISSA LEGARDA
Credential	:
Telephone Number	:	650-273-8181

Provider Enumeration Date	:	04/12/2007
Last Update Date	:	08/22/2020

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