Provider Demographics
NPI:1275921231
Name:C & C'S CARE HOME
Entity Type:Organization
Organization Name:C & C'S CARE HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ETHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GUMBAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-228-3777
Mailing Address - Street 1:2700 OAKMONT DR.
Mailing Address - Street 2:
Mailing Address - City:SAN BRUNO
Mailing Address - State:CA
Mailing Address - Zip Code:94066
Mailing Address - Country:US
Mailing Address - Phone:650-228-3777
Mailing Address - Fax:650-871-8290
Practice Address - Street 1:2700 OAKMONT DR.
Practice Address - Street 2:
Practice Address - City:SAN BRUNO
Practice Address - State:CA
Practice Address - Zip Code:94066
Practice Address - Country:US
Practice Address - Phone:650-228-3777
Practice Address - Fax:650-871-8290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-29
Last Update Date:2014-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA415600425310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility