Organization
C.R.E. ENTERPRISE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. EVELYN BALATBAT RYAN RNBSN (PROVIDER)
(650) 340-0025
Entity
Organization
Contact information
Practice address
2601 COTTONWOOD DR, SAN BRUNO, CA 94066-2619
(650) 303-6813
(650) 340-0414
Mailing address
2601 COTTONWOOD DR., SAN BRUNO, CA 94066-2619
(650) 303-6813
(650) 340-0414
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
220000365
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LTC60835F
EDS PROVIDER NUMBER CW
CA
Enumeration date
02/07/2007
Last updated
05/01/2009
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