Provider Demographics
NPI:1083004782
Name:STEPHANIE HOME INC.
Entity Type:Organization
Organization Name:STEPHANIE HOME INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DEYRA
Authorized Official - Middle Name:
Authorized Official - Last Name:SUNGA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:650-892-4572
Mailing Address - Street 1:2893 EL CAMINO REAL STE C
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94061-4039
Mailing Address - Country:US
Mailing Address - Phone:650-216-9960
Mailing Address - Fax:650-216-9455
Practice Address - Street 1:776 DEL MONTE AVE
Practice Address - Street 2:
Practice Address - City:SOUTH SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94080-2230
Practice Address - Country:US
Practice Address - Phone:650-757-7115
Practice Address - Fax:650-991-3979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-02
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA313M00000X, 315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
No315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities