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Organization
BENNETT VALLEY ICF DDH INC
Active
Organization
BENNETT VALLEY ICF DDH INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JULIE G ALBERO (DIRECTOR)
(650) 544-8999
Entity
Organization
Contact information
Practice address
2416 CACTUS AVENUE, SANTA ROSA, CA 95405
(707) 544-6465
(650) 347-8887
Mailing address
2040 SEA CLIFF WAY, SAN BRUNO, CA 94066
(650) 544-8999
(650) 347-8887
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
55 G072
MEDICAL
CA
Enumeration date
01/11/2007
Last updated
08/22/2020
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