MEDICARE: LAO FAMILY COMMUNITY DEVELOPMENT, INC.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	251B00000X	Case Management Agency
2	251C00000X	Developmentally Disabled Services Day Training Agency
3	251X00000X	Supports Brokerage Agency

General Provider Information

NPI Number	:	1255198115
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAO FAMILY COMMUNITY DEVELOPMENT, INC.

Provider Business Mailing Address
First Line	:	2325 E 12TH ST STE 226
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94601-1014
Country	:	US
Telephone Number	:	510-533-8850
Fax Number	:

Provider Business Practice Location Address
First Line	:	7171 BOWLING DR STE 1120
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95823-2040
Country	:	US
Telephone Number	:	916-393-7501
Fax Number	:

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	KATHY CHAO ROTHBERG
Credential	:
Telephone Number	:	510-533-8850

Provider Enumeration Date	:	03/06/2024
Last Update Date	:	03/06/2024

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