Provider Demographics
NPI:1619369808
Name:PETAR GUEST HOMES, INC.
Entity type:Organization
Organization Name:PETAR GUEST HOMES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GHOLAM
Authorized Official - Middle Name:REZA
Authorized Official - Last Name:KEYHANTAJ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-360-2936
Mailing Address - Street 1:902 DIABLO RD
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94526-1922
Mailing Address - Country:US
Mailing Address - Phone:925-855-0959
Mailing Address - Fax:
Practice Address - Street 1:902 DIABLO RD
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:CA
Practice Address - Zip Code:94526-1922
Practice Address - Country:US
Practice Address - Phone:925-855-0959
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PETAR GUEST HOMES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-02-24
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA075600230310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility