Provider Demographics
NPI:1245605252
Name:STETSON COURT LIVING, LLC
Entity Type:Organization
Organization Name:STETSON COURT LIVING, LLC
Other - Org Name:STETSON COURT LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:GAOIRAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-876-9445
Mailing Address - Street 1:3913 STETSON CT
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95206-6089
Mailing Address - Country:US
Mailing Address - Phone:209-910-9138
Mailing Address - Fax:877-683-4513
Practice Address - Street 1:3913 STETSON CT
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95206-6089
Practice Address - Country:US
Practice Address - Phone:209-910-9138
Practice Address - Fax:877-683-4513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-02
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA397005195385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care