Provider Demographics
NPI:1003027491
Name:TUPAZ HOME # 9
Entity Type:Organization
Organization Name:TUPAZ HOME # 9
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BEEBE
Authorized Official - Middle Name:
Authorized Official - Last Name:TUPAZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-377-1622
Mailing Address - Street 1:2831 CORTINA WAY
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94587-1553
Mailing Address - Country:US
Mailing Address - Phone:408-377-1622
Mailing Address - Fax:
Practice Address - Street 1:1602 ORCHARD VIEW DR
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-6424
Practice Address - Country:US
Practice Address - Phone:408-448-5411
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-25
Last Update Date:2009-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALTC80035G315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities