Organization
BAY HORIZON ICF-DDH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS PUREZA AGUZAR GANIO (CEO)
(650) 520-5545
Entity
Organization
Contact information
Practice address
516 OCEAN VIEW AVE, SAN MATEO, CA 94401-3029
(650) 347-1164
(650) 348-2795
Mailing address
1565 ROYAL AVE, SAN MATEO, CA 94401-3432
(650) 347-1164
(650) 348-2795
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
220000319
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LTC60671G
PROVIDER NUMBER
CA
Enumeration date
02/25/2015
Last updated
02/25/2015
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