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Organization
LARCHMONT HOME
Active
Organization
LARCHMONT HOME
Active
Parent organization
4JS HOME INC.
Organization subpart
Yes
Provider details
NPI number
Legal business name
4JS HOME INC.
Authorized official
MS. YOLANDA RUIZ (LICENSEE/CFO)
(650) 303-0788
Entity
Organization
Contact information
Practice address
627 LARCHMONT DR, DALY CITY, CA 94015-3637
(650) 994-3673
Mailing address
627 LARCHMONT DR, DALY CITY, CA 94015-3637
(650) 994-3673
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
LTC60988F
—
CA
Enumeration date
04/01/2008
Last updated
04/01/2008
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