Provider Demographics
NPI:1023408929
Name:ADAMS ICF/DD-N
Entity type:Organization
Organization Name:ADAMS ICF/DD-N
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DEYRA
Authorized Official - Middle Name:
Authorized Official - Last Name:SUNGA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:650-892-4572
Mailing Address - Street 1:2893 EL CAMINO REAL STE C
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94061-4039
Mailing Address - Country:US
Mailing Address - Phone:650-216-9960
Mailing Address - Fax:650-216-9455
Practice Address - Street 1:1778 ADAMS ST
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94403-1108
Practice Address - Country:US
Practice Address - Phone:650-522-8101
Practice Address - Fax:650-525-0411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-29
Last Update Date:2015-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
No315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities