Organization
HALE KOKUA, INC.
Active
Other names
Bay Horizon ICF / DDH
Organization subpart
No
Provider details
NPI number
Authorized official
MISS PUREZA A. GANIO (LICENSEE)
(650) 520-5545
Entity
Organization
Contact information
Practice address
516 OCEAN VIEW AVE, SAN MATEO, CA 94401-3029
(650) 347-1164
Mailing address
1433 DAKOTA AVENUE, SAN MATEO, CA 94401
(650) 685-4779
(650) 627-4357
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
07/02/2007
Last updated
01/21/2015
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