Provider Demographics
NPI:1851694608
Name:NAZARETH CLASSIC CARE COMMUNITY INC
Entity Type:Organization
Organization Name:NAZARETH CLASSIC CARE COMMUNITY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:HANNA
Authorized Official - Middle Name:FARID
Authorized Official - Last Name:HANHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:650-347-9500
Mailing Address - Street 1:800 SOUTH B STREET
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401-4272
Mailing Address - Country:US
Mailing Address - Phone:650-347-9500
Mailing Address - Fax:650-347-9400
Practice Address - Street 1:800 ROBLE AVE
Practice Address - Street 2:
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-4908
Practice Address - Country:US
Practice Address - Phone:650-322-4100
Practice Address - Fax:650-322-1508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-17
Last Update Date:2010-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA415600741310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA415600741OtherCALIFORNIA DEPARTMENT OF SOCIAL SERVICES