Provider Demographics
NPI:1750956983
Name:HUMPHREYS GUEST HOME CORPORATION
Entity type:Organization
Organization Name:HUMPHREYS GUEST HOME CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:ALLAN
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-251-7461
Mailing Address - Street 1:511 G ST
Mailing Address - Street 2:
Mailing Address - City:GALT
Mailing Address - State:CA
Mailing Address - Zip Code:95632-1949
Mailing Address - Country:US
Mailing Address - Phone:209-251-7461
Mailing Address - Fax:209-912-4036
Practice Address - Street 1:511 G ST
Practice Address - Street 2:
Practice Address - City:GALT
Practice Address - State:CA
Practice Address - Zip Code:95632-1949
Practice Address - Country:US
Practice Address - Phone:209-251-7461
Practice Address - Fax:209-912-4036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-20
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home