Provider Demographics
NPI:1497040117
Name:HILLSBOROUGH MANOR INC.
Entity Type:Organization
Organization Name:HILLSBOROUGH MANOR INC.
Other - Org Name:SUNRISE ICF/DD-H
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSEMARIE
Authorized Official - Middle Name:TAMBOT
Authorized Official - Last Name:VERIDIANO
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:650-580-2983
Mailing Address - Street 1:2893 EL CAMINO REAL, STE. C
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94061
Mailing Address - Country:US
Mailing Address - Phone:650-216-9960
Mailing Address - Fax:650-216-9455
Practice Address - Street 1:1776 ADAMS ST
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94403-1108
Practice Address - Country:US
Practice Address - Phone:650-578-1091
Practice Address - Fax:650-216-9455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-10
Last Update Date:2011-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA315P00000X315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities