Provider Demographics
NPI:1164081089
Name:ANTON'S HOME, INC.
Entity Type:Organization
Organization Name:ANTON'S HOME, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ESTELITA
Authorized Official - Middle Name:SANTIAGO
Authorized Official - Last Name:EVANGELISTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-987-3401
Mailing Address - Street 1:4358 CALLAN BLVD.
Mailing Address - Street 2:
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94015-4404
Mailing Address - Country:US
Mailing Address - Phone:415-987-3401
Mailing Address - Fax:650-878-3131
Practice Address - Street 1:2598 OLYMPIC DRIVE,
Practice Address - Street 2:
Practice Address - City:SAN BRUNO
Practice Address - State:CA
Practice Address - Zip Code:94066-1251
Practice Address - Country:US
Practice Address - Phone:650-553-5009
Practice Address - Fax:850-878-3131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-13
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities