Provider Demographics
NPI:1104011097
Name:VEALS RESIDENTIAL CARE HOME
Entity Type:Organization
Organization Name:VEALS RESIDENTIAL CARE HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KEIKO
Authorized Official - Middle Name:
Authorized Official - Last Name:KANEZAKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-333-3816
Mailing Address - Street 1:69 LOBOS STREET
Mailing Address - Street 2:
Mailing Address - City:SAN FRANSISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94112
Mailing Address - Country:US
Mailing Address - Phone:415-333-3816
Mailing Address - Fax:415-585-1854
Practice Address - Street 1:65 LOBOS STREET
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94112
Practice Address - Country:US
Practice Address - Phone:415-333-3816
Practice Address - Fax:415-585-1854
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-13
Last Update Date:2007-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness