Organization
ANTIOCH ICF INC
Active
Other names
San Juan ICF
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ROSEMARIE TAMBOT VERIDIANO PHARMACIST (PRESIDENT ADMINISTRATOR)
(650) 580-2983
Entity
Organization
Contact information
Practice address
3117 SAN JUAN CT, ANTIOCH, CA 94509-5313
(925) 778-4855
(925) 978-9005
Mailing address
2893 EL CAMINO REAL, SUITE C, REDWOOD CITY, CA 94061-4001
(650) 216-9960
(650) 216-9455
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
55G491
LONG TERM CARE
CA
Enumeration date
04/20/2007
Last updated
08/22/2020
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