Organization
HAKE KOKUA, INC.
Active
Other names
Dakota ICF / DDH
Organization subpart
No
Provider details
NPI number
Authorized official
MISS PUREZA A. GANIO (CEO)
(650) 520-5545
Entity
Organization
Contact information
Practice address
1433 DAKOTA AVE, SAN MATEO, CA 94401-3007
(650) 685-4779
Mailing address
1433 DAKOTA AVENUE, SAN MATEO, CA 94401
(650) 685-4779
(650) 627-4357
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
220000380
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LTC60389H
PROVIDER NUMBER
CA
Enumeration date
07/02/2007
Last updated
01/22/2015
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