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NPI 1821200783 · Intellectual Disabilities Intermediate Care Facility · San Mateo, CA
Provider details
- NPI number
- 1821200783
- Entity type
- Organization
- Primary specialty
- Intellectual Disabilities Intermediate Care FacilityNursing & Custodial Care Facilities
- Organization subpart
- No
- Authorized official
- Vicky Ting, President/Administrator/ Owner(925) 813-1979
- License
- 220000351 (CA)
Specialties & taxonomies
Nursing & Custodial Care Facilities
Practice location
1209 Dakota Ave
San Mateo, CA 94401
Phone: (650) 548-1903
Fax: (650) 548-1991
Approximate (ZIP-level) locationGet directions
Mailing address
2009 Fitzgerald Way
Brentwood, CA 94513
Registry dates
- Enumerated
- 2007-05-04
- Last updated
- 2024-02-24
- Certified
- 2024-02-24
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.