Organization
EXCELLENT CARE PROVIDER INC
Active
Other names
Kathryne Manor ICF/DD-H
Organization subpart
No
Provider details
NPI number
Authorized official
AVELINA Q ALFONSO (OWNER/PRESIDENT)
(650) 255-1072
Entity
Organization
Contact information
Practice address
840 KATHRYNE AVE, SAN MATEO, CA 94401-3125
(650) 703-3532
(650) 583-8224
Mailing address
840 KATHRYNE AVE, SAN MATEO, CA 94401-3125
(650) 703-3532
(650) 583-8224
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
220000364
CA
Other
Enumeration date
06/16/2015
Last updated
06/16/2015
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