Excellent Care Provider Inc

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

License

220000364 Issued in CA

Legal business name

EXCELLENT CARE PROVIDER INC

Doing business as

Kathryne Manor ICF/DD-H

Practice address

840 Kathryne Ave
San Mateo, CA 94401-3125

Phone

(650) 703-3532

Fax

(650) 583-8224

NPI assigned

Jun 16, 2015

Organization subpart

No

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

Authorized official

Name

Avelina Q Alfonso

Title

Owner/President

Phone

(650) 255-1072

Specialties & licenses 1

Addresses

Other names 1

• Kathryne Manor ICF/DD-H Doing business as

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

{
    "created_epoch": "1434412800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1434412800000",
    "number": "1982085981",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "840 KATHRYNE AVE",
            "city": "SAN MATEO",
            "state": "CA",
            "postal_code": "944013125",
            "telephone_number": "650-703-3532",
            "fax_number": "650-583-8224"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "840 KATHRYNE AVE",
            "city": "SAN MATEO",
            "state": "CA",
            "postal_code": "944013125",
            "telephone_number": "650-703-3532",
            "fax_number": "650-583-8224"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXCELLENT CARE PROVIDER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-06-16",
        "last_updated": "2015-06-16",
        "status": "A",
        "authorized_official_last_name": "ALFONSO",
        "authorized_official_first_name": "AVELINA",
        "authorized_official_middle_name": "Q",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "650-255-1072"
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "CA",
            "license": "220000364",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kathryne Manor ICF/DD-H",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in San Mateo, CA
• Providers in San Mateo, CA by specialty
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2015; 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.