Provider Demographics
NPI:1164974788
Name:SAINT ANNE VILLAGE INC
Entity Type:Organization
Organization Name:SAINT ANNE VILLAGE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:R
Authorized Official - Last Name:NEUBAUER
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:925-240-4757
Mailing Address - Street 1:PO BOX 374
Mailing Address - Street 2:
Mailing Address - City:BYRON
Mailing Address - State:CA
Mailing Address - Zip Code:94514-0374
Mailing Address - Country:US
Mailing Address - Phone:925-240-4757
Mailing Address - Fax:925-634-4194
Practice Address - Street 1:2800 CAMINO DIABLO
Practice Address - Street 2:
Practice Address - City:BYRON
Practice Address - State:CA
Practice Address - Zip Code:94514-0476
Practice Address - Country:US
Practice Address - Phone:925-240-4757
Practice Address - Fax:925-634-4194
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-31
Last Update Date:2016-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA079200544385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care