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Individual

MS. HALLEY IRENE CRUMB

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
ADULT RESIDENTIAL

Contact information

Practice address
16236 N LAKE ST, MADERA, CA 93638-1615
(650) 461-0433
Mailing address
2785 JOSEPH AVE APT 4, CAMPBELL, CA 95008-6259
(650) 461-0433

Taxonomy

Speciality
Code
Description
License number
State
3747A0650X
Attendant Care Provider
Primary
6031500735
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
6031500735
COMMUNITY CARE LICENSE DIVISION
CA
Enumeration date
04/14/2020
Last updated
06/16/2021
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