Provider Demographics
NPI:1316776628
Name:APOSTOL, SAMUEL C (ADM)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:C
Last Name:APOSTOL
Suffix:
Gender:M
Credentials:ADM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:460 CHURCH AVE
Mailing Address - Street 2:
Mailing Address - City:SAN MARTIN
Mailing Address - State:CA
Mailing Address - Zip Code:95046-9778
Mailing Address - Country:US
Mailing Address - Phone:408-439-1962
Mailing Address - Fax:408-683-0278
Practice Address - Street 1:460 CHURCH AVE
Practice Address - Street 2:
Practice Address - City:SAN MARTIN
Practice Address - State:CA
Practice Address - Zip Code:95046-9778
Practice Address - Country:US
Practice Address - Phone:408-439-1962
Practice Address - Fax:408-683-0278
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-26
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA435294143251S00000X, 310400000X, 3104A0630X, 311ZA0620X, 3104A0625X
310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
No251S00000XAgenciesCommunity/Behavioral Health
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances
No311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home