| NPI | 1730708637 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NOEL DE JESUS Executive Director 408-531-9126 |
| Organization Subpart ? | No |
| Primary Taxonomy | 315P00000X Intermediate Care Facility, Mentally Retarded |
| Additional Taxonomies | 313M00000X Nursing Facility/Intermediate Care Facility |
| Enumeration Date | 2020-04-10 |
| Last Update Date | 2020-04-10 |