Organization
LENA'S HOUSE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EUGENE ANATOL KONDRAKHIN (ADMINISTRATOR)
(831) 578-2217
Entity
Organization
Contact information
Practice address
1075 MERIDIAN ST, HOLLISTER, CA 95023-4144
(831) 638-2137
Mailing address
1970 OLGA DR., HOLLISTER, CA 95023
(831) 578-2217
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
070000648
CA
Other
Enumeration date
03/03/2007
Last updated
04/13/2012
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