Provider Demographics
NPI:1386784312
Name:C.R.E. ENTERPRISE, INC.
Entity type:Organization
Organization Name:C.R.E. ENTERPRISE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:EVELYN
Authorized Official - Middle Name:BALATBAT
Authorized Official - Last Name:RYAN
Authorized Official - Suffix:
Authorized Official - Credentials:RNBSN
Authorized Official - Phone:650-340-0025
Mailing Address - Street 1:2601 COTTONWOOD DR.
Mailing Address - Street 2:
Mailing Address - City:SAN BRUNO
Mailing Address - State:CA
Mailing Address - Zip Code:94066-2619
Mailing Address - Country:US
Mailing Address - Phone:650-303-6813
Mailing Address - Fax:650-340-0414
Practice Address - Street 1:2601 COTTONWOOD DR
Practice Address - Street 2:
Practice Address - City:SAN BRUNO
Practice Address - State:CA
Practice Address - Zip Code:94066-2619
Practice Address - Country:US
Practice Address - Phone:650-303-6813
Practice Address - Fax:650-340-0414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2009-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA220000365315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALTC60835FOtherEDS PROVIDER NUMBER CW