Organization
LESTERS HOME INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LOUIE BARANGAN (QIDP)
(650) 388-2507
Entity
Organization
Contact information
Practice address
3271 SUSAN DR, SAN BRUNO, CA 94066-1639
(650) 359-7865
(650) 359-7865
Mailing address
3271 SUSAN DR, SAN BRUNO, CA 94066-1639
(650) 359-7865
(650) 359-7865
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
220000483
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
LTC61017F
—
CA
Enumeration date
03/09/2015
Last updated
03/09/2015
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