Provider Demographics
NPI:1568905958
Name:ANGELS MANOR CARE HOME
Entity Type:Organization
Organization Name:ANGELS MANOR CARE HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LINCESEE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ELMA
Authorized Official - Middle Name:L
Authorized Official - Last Name:FERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-272-8655
Mailing Address - Street 1:1021 HEATHERFIELD LN
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95132-2931
Mailing Address - Country:US
Mailing Address - Phone:408-272-8655
Mailing Address - Fax:408-258-1328
Practice Address - Street 1:1021 HEATHERFIELD LN
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95132-2931
Practice Address - Country:US
Practice Address - Phone:408-272-8655
Practice Address - Fax:408-258-1328
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-02
Last Update Date:2016-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility