Provider Demographics
NPI:1760701486
Name:LYRICETE, LLC
Entity type:Organization
Organization Name:LYRICETE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TIANA
Authorized Official - Middle Name:DANIELLE
Authorized Official - Last Name:BLUNT
Authorized Official - Suffix:
Authorized Official - Credentials:LVN
Authorized Official - Phone:415-410-1985
Mailing Address - Street 1:279 TEDDY AVE APT A
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94134-2339
Mailing Address - Country:US
Mailing Address - Phone:800-695-1106
Mailing Address - Fax:800-695-1106
Practice Address - Street 1:279 TEDDY AVE APT A
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94134-2339
Practice Address - Country:US
Practice Address - Phone:800-695-1106
Practice Address - Fax:800-695-1106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-19
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN192915310400000X, 311ZA0620X, 164X00000X
CAC5720996347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164X00000XNursing Service ProvidersLicensed Vocational NurseGroup - Single Specialty
No310400000XNursing & Custodial Care FacilitiesAssisted Living FacilityGroup - Single Specialty
No311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
No347C00000XTransportation ServicesPrivate Vehicle