Organization
CONNIE'S ICF DD-H
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CONCEPCION T ANCHETA ADMINISTRATOR (ADMINISTRATOR)
(650) 678-8142
Entity
Organization
Contact information
Practice address
237 KENT PL, SAN RAMON, CA 94583-3728
(925) 829-1938
(925) 829-1938
Mailing address
1117 TANGLEWOOD WAY, SAN MATEO, CA 94403-4919
(650) 678-8142
(650) 638-2590
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
140000703
CA
Other
Enumeration date
03/07/2007
Last updated
02/19/2008
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