Provider Demographics
NPI:1407175680
Name:AMERICAN STAR HOME 5 ICF/DD-N
Entity Type:Organization
Organization Name:AMERICAN STAR HOME 5 ICF/DD-N
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ADMINISTRATOR/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:VICKY
Authorized Official - Middle Name:SANTOS
Authorized Official - Last Name:TING
Authorized Official - Suffix:
Authorized Official - Credentials:BSN
Authorized Official - Phone:925-813-1979
Mailing Address - Street 1:2009 FITZGERALD WAY
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:94513-2368
Mailing Address - Country:US
Mailing Address - Phone:925-813-1979
Mailing Address - Fax:925-420-6748
Practice Address - Street 1:1627 SHOREVIEW AVENUE
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-3033
Practice Address - Country:US
Practice Address - Phone:650-579-6588
Practice Address - Fax:650-579-6590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-26
Last Update Date:2024-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities