Derry Way Home

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

415600901 Issued in CA

Legal business name

DERRY WAY HOME

Practice address

2243 Derry Way
South San Francisco, CA 94080-5506

Phone

(650) 763-1152

NPI assigned

Oct 17, 2014

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Kwai Kwong Liu, RN

Title

Administrator

Phone

(650) 219-7930

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1413504000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1413504000000",
    "number": "1235533316",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2243 DERRY WAY",
            "city": "SOUTH SAN FRANCISCO",
            "state": "CA",
            "postal_code": "940805506",
            "telephone_number": "650-763-1152"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2243 DERRY WAY",
            "city": "SOUTH SAN FRANCISCO",
            "state": "CA",
            "postal_code": "940805506",
            "telephone_number": "650-763-1152"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DERRY WAY HOME",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-17",
        "last_updated": "2014-10-17",
        "status": "A",
        "authorized_official_last_name": "LIU",
        "authorized_official_first_name": "KWAI",
        "authorized_official_middle_name": "KWONG",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "650-219-7930",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "CA",
            "license": "415600901",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Assisted Living Facility in South San Francisco, CA
• Providers in South San Francisco, CA by specialty
• Assisted Living Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.