Provider Demographics
NPI:1891541611
Name:TABONES, FELOMENA (CARE HOME)
Entity type:Individual
Prefix:
First Name:FELOMENA
Middle Name:
Last Name:TABONES
Suffix:
Gender:F
Credentials:CARE HOME
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5017 SAINT GARRETT CT
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94521-3619
Mailing Address - Country:US
Mailing Address - Phone:925-664-1941
Mailing Address - Fax:925-332-5618
Practice Address - Street 1:5017 SAINT GARRETT CT
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94521-3619
Practice Address - Country:US
Practice Address - Phone:925-698-4428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-24
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA079201267311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home