1164081089 NPI number — ANTON'S HOME, INC.

Table of content: (NPI 1164081089)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164081089 NPI number — ANTON'S HOME, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANTON'S HOME, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1164081089
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/13/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4358 CALLAN BLVD.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALY CITY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94015-4404
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
415-987-3401
Provider Business Mailing Address Fax Number:
650-878-3131

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2598 OLYMPIC DRIVE,
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN BRUNO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94066-1251
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
650-553-5009
Provider Business Practice Location Address Fax Number:
850-878-3131
Provider Enumeration Date:
06/13/2019

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
EVANGELISTA
Authorized Official First Name:
ESTELITA
Authorized Official Middle Name:
SANTIAGO
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
415-987-3401

Provider Taxonomy Codes

  • Taxonomy code: 315P00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)