Organization
ALMA M MEDINA
Active
Other names
VESTAL HOUSE ICFDDH
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ALMA M MEDINA (SUPERVISOR)
(650) 455-2574
Entity
Organization
Contact information
Practice address
2076 VESTAL CT, SAN LEANDRO, CA 94577-2328
(650) 455-2574
Mailing address
2076 VESTAL CT, SAN LEANDRO, CA 94577-2328
(650) 455-2574
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
55G396
PROVIDER NUMBER
CA
Enumeration date
05/17/2007
Last updated
08/22/2020
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