Provider Demographics
NPI:1669193827
Name:PROVIDENCE HOME OF MODESTO INC.
Entity type:Organization
Organization Name:PROVIDENCE HOME OF MODESTO INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WARREN
Authorized Official - Middle Name:
Authorized Official - Last Name:DELFIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-201-6025
Mailing Address - Street 1:851 BURLWAY RD.
Mailing Address - Street 2:SUITE 216
Mailing Address - City:BURLINGAME
Mailing Address - State:CA
Mailing Address - Zip Code:94010-1720
Mailing Address - Country:US
Mailing Address - Phone:650-581-1359
Mailing Address - Fax:
Practice Address - Street 1:670 PARADISE AVE
Practice Address - Street 2:
Practice Address - City:MODESTA
Practice Address - State:CA
Practice Address - Zip Code:95351-3110
Practice Address - Country:US
Practice Address - Phone:209-497-6691
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PROVIDENCE HOME OF MODESTO INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-09-07
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based