Provider Demographics
NPI:1376072637
Name:LEE'S CARE HOME
Entity Type:Organization
Organization Name:LEE'S CARE HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CORAZON
Authorized Official - Middle Name:ESPOSO
Authorized Official - Last Name:MILLARES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-768-4189
Mailing Address - Street 1:5225 GALLANT FOX AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95111-2853
Mailing Address - Country:US
Mailing Address - Phone:408-841-9508
Mailing Address - Fax:408-904-5344
Practice Address - Street 1:5225 GALLANT FOX AVENUE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95131
Practice Address - Country:US
Practice Address - Phone:408-841-9508
Practice Address - Fax:408-904-5344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA435294105310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility