Provider Demographics
NPI:1427255827
Name:STA INES CARE HOME INC
Entity type:Organization
Organization Name:STA INES CARE HOME INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LEONILA
Authorized Official - Middle Name:
Authorized Official - Last Name:REYES SALOMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-759-8518
Mailing Address - Street 1:1644 YORKTOWN RD
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94402-4038
Mailing Address - Country:US
Mailing Address - Phone:650-759-8518
Mailing Address - Fax:
Practice Address - Street 1:1644 YORKTOWN RD
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94402-4038
Practice Address - Country:US
Practice Address - Phone:650-759-8518
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-29
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities