NPIMap

Organization Active NPI

C.R.E. Enterprise, Inc.

  • Intellectual Disabilities Intermediate Care Facility
  • San Bruno, CA
National Provider Identifier
1386784312
Registry record updated May 1, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
License
220000365 Issued in CA
Legal business name
C.R.E. ENTERPRISE, INC.
Practice address
2601 Cottonwood Dr
San Bruno, CA 94066-2619
Phone
(650) 303-6813
Fax
(650) 340-0414
NPI assigned
Feb 7, 2007
Last updated
May 1, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 1, 2009

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

Authorized official

Name
Mrs. Evelyn Balatbat Ryan, RNBSN
Title
Provider
Phone
(650) 340-0025

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X 220000365 CA Primary

Addresses

Primary practice location

2601 Cottonwood Dr
San Bruno, CA 94066-2619

Mailing address

2601 Cottonwood Dr.
San Bruno, CA 94066-2619
Phone (650) 303-6813

Other identifiers 1

IdentifierTypeStateIssuer
LTC60835FOtherCAEDS PROVIDER NUMBER CW

National Provider Directory

National Provider Directory
Tax ID family
Cre Enterprise Inc4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1170806400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1241136000000",
    "number": "1386784312",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2601 COTTONWOOD DR.",
            "city": "SAN BRUNO",
            "state": "CA",
            "postal_code": "940662619",
            "telephone_number": "650-303-6813",
            "fax_number": "650-340-0414"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2601 COTTONWOOD DR",
            "city": "SAN BRUNO",
            "state": "CA",
            "postal_code": "940662619",
            "telephone_number": "650-303-6813",
            "fax_number": "650-340-0414"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "C.R.E. ENTERPRISE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-07",
        "last_updated": "2009-05-01",
        "status": "A",
        "authorized_official_last_name": "RYAN",
        "authorized_official_first_name": "EVELYN",
        "authorized_official_middle_name": "BALATBAT",
        "authorized_official_title_or_position": "PROVIDER",
        "authorized_official_telephone_number": "650-340-0025",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "RNBSN"
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "CA",
            "license": "220000365",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EDS PROVIDER NUMBER CW",
            "identifier": "LTC60835F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Bruno, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2009; 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.