Organization
ANGEL PRESTIGE RESIDENTIAL CARE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HERMANDO ESGUERRA (ADMINISTRATOR)
(408) 568-0615
Entity
Organization
Contact information
Practice address
3305 MARCEL COURT, SAN JOSE, CA 95135
(408) 440-0920
Mailing address
3305 MARCEL COURT, SAN JOSE, CA 95135
(408) 440-0920
Taxonomy
Speciality
Code
Description
License number
State
225400000X
Rehabilitation Practitioner
Primary
RN41086
NV
311ZA0620X
Adult Care Home Facility
3220AGC-13
NV
311ZA0620X
Adult Care Home Facility
4185AGC-6
NV
Other
Enumeration date
12/30/2011
Last updated
01/23/2012
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