| NPI | 1447427406 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CARLA MCCORMACK Licensee 408-713-2770 |
| Organization Subpart ? | No |
| Primary Taxonomy | 315P00000X Intermediate Care Facility, Mentally Retarded (Licence: CA 230000271) |
| Additional Taxonomies | 313M00000X Nursing Facility/Intermediate Care Facility |
| Enumeration Date | 2008-05-09 |
| Last Update Date | 2014-04-09 |