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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