Provider Demographics
NPI:1154714616
Name:LESTERS HOME INC.
Entity type:Organization
Organization Name:LESTERS HOME INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:QIDP
Authorized Official - Prefix:MR
Authorized Official - First Name:LOUIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BARANGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-388-2507
Mailing Address - Street 1:3271 SUSAN DR
Mailing Address - Street 2:
Mailing Address - City:SAN BRUNO
Mailing Address - State:CA
Mailing Address - Zip Code:94066-1639
Mailing Address - Country:US
Mailing Address - Phone:650-359-7865
Mailing Address - Fax:650-359-7865
Practice Address - Street 1:3271 SUSAN DR
Practice Address - Street 2:
Practice Address - City:SAN BRUNO
Practice Address - State:CA
Practice Address - Zip Code:94066-1639
Practice Address - Country:US
Practice Address - Phone:650-359-7865
Practice Address - Fax:650-359-7865
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-09
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA220000483320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALTC61017FMedicaid