Provider Demographics
NPI:1922295575
Name:LUCYS BOARD & CARE HOME
Entity Type:Organization
Organization Name:LUCYS BOARD & CARE HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSEE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LUZ
Authorized Official - Middle Name:CONCEPCION
Authorized Official - Last Name:YPARRAGUIRRE
Authorized Official - Suffix:
Authorized Official - Credentials:BSN RN
Authorized Official - Phone:415-643-6125
Mailing Address - Street 1:3328 21ST ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-2317
Mailing Address - Country:US
Mailing Address - Phone:415-643-6125
Mailing Address - Fax:415-643-5626
Practice Address - Street 1:3328 21ST ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-2317
Practice Address - Country:US
Practice Address - Phone:415-643-6125
Practice Address - Fax:415-643-5626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-27
Last Update Date:2007-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness