# LARCHMONT HOME

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** 4JS HOME INC.
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1043482862
- **Legal business name:** 4JS HOME INC.
- **Authorized official:** MS. YOLANDA RUIZ (LICENSEE/CFO)
- **Authorized official phone:** (650) 303-0788

## Contact information

- **Practice address:** 627 LARCHMONT DR, DALY CITY, CA 94015-3637
- **Practice address phone:** (650) 994-3673
- **Mailing address:** 627 LARCHMONT DR, DALY CITY, CA 94015-3637
- **Mailing address phone:** (650) 994-3673

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 320600000X | Intellectual and/or Developmental Disabilities Residential Treatment Facility | — | CA | Yes |

## Other

- **Enumeration date:** 04/01/2008
- **Last updated:** 04/01/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | LTC60988F | — | CA |