Provider Demographics
NPI:1174569743
Name:PALMERO ENTERPRISES INC.
Entity type:Organization
Organization Name:PALMERO ENTERPRISES INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SHANE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCORMACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-961-6161
Mailing Address - Street 1:2530 SOLACE PLACE
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-4309
Mailing Address - Country:US
Mailing Address - Phone:650-961-6161
Mailing Address - Fax:650-967-7878
Practice Address - Street 1:2530 SOLACE PL
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040-4309
Practice Address - Country:US
Practice Address - Phone:650-961-6161
Practice Address - Fax:650-967-7878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-21
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA220000410314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZR05316GMedicaid
CAR05316GMedicaid
CA055316Medicare PIN
CAR05316GMedicaid