Provider Demographics
NPI:1992196240
Name:BURLINGAME VILLA
Entity Type:Organization
Organization Name:BURLINGAME VILLA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:JANGAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-278-9515
Mailing Address - Street 1:1117 RHINETTE AVE
Mailing Address - Street 2:
Mailing Address - City:BURLINGAME
Mailing Address - State:CA
Mailing Address - Zip Code:94010-3419
Mailing Address - Country:US
Mailing Address - Phone:650-344-7074
Mailing Address - Fax:
Practice Address - Street 1:1117 RHINETTE AVE
Practice Address - Street 2:
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-3419
Practice Address - Country:US
Practice Address - Phone:650-344-7074
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-09
Last Update Date:2015-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA410508825310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility