Provider Demographics
NPI:1609332493
Name:AMD ALTERNATIVE CARE SERVICES
Entity Type:Organization
Organization Name:AMD ALTERNATIVE CARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:DAWANA
Authorized Official - Last Name:BUCCAT
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:650-296-9425
Mailing Address - Street 1:278 CERRO DR
Mailing Address - Street 2:
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94015-4083
Mailing Address - Country:US
Mailing Address - Phone:650-296-9425
Mailing Address - Fax:650-758-4732
Practice Address - Street 1:2639 SHEPPARD WAY
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94509-4354
Practice Address - Country:US
Practice Address - Phone:925-238-0747
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMD ALTERNATIVE CARE SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-02-16
Last Update Date:2019-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities