Provider Demographics
NPI:1518253020
Name:SERVICE LEAGUE OF SAN MATEO COUNTY
Entity Type:Organization
Organization Name:SERVICE LEAGUE OF SAN MATEO COUNTY
Other - Org Name:HOPE HOUSE
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:FRANCONE
Authorized Official - Suffix:
Authorized Official - Credentials:CADAC II
Authorized Official - Phone:650-364-4664
Mailing Address - Street 1:727 MIDDLEFIELD ROAD
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94063-4504
Mailing Address - Country:US
Mailing Address - Phone:650-364-4664
Mailing Address - Fax:650-365-6817
Practice Address - Street 1:3789 HOOVER ST
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94063-4504
Practice Address - Country:US
Practice Address - Phone:650-363-8735
Practice Address - Fax:650-363-8701
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SERVICE LEAGUE OF SAN MATEO COUNTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-06-22
Last Update Date:2014-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA410013AN324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility