| NPI | 1508485376 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NOEL DE JESUS Executive Director 408-531-9126 |
| Organization Subpart ? | No |
| Primary Taxonomy | 315P00000X Intermediate Care Facility, Mentally Retarded |
| Enumeration Date | 2020-04-13 |
| Last Update Date | 2020-04-13 |