Basic Information
| Provider Information | |||||||||
| NPI: | 1669797759 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HOMESTART | ||||||||
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| Mailing Information | |||||||||
| Address1: | 30 LAS COLINAS LN | ||||||||
| Address2: | |||||||||
| City: | SAN JOSE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 951191212 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4082842812 | ||||||||
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| Practice Location | |||||||||
| Address1: | 30 LAS COLINAS LN | ||||||||
| Address2: | |||||||||
| City: | SAN JOSE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 951191212 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4082842812 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/31/2010 | ||||||||
| LastUpdateDate: | 03/14/2022 | ||||||||
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| AuthorizedOfficialLastName: | PERKINS | ||||||||
| AuthorizedOfficialFirstName: | VICKEY | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PROGRAM MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 4082842812 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | HOPE SERVICES, INC | ||||||||
| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| NPICertificationDate: | 03/14/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2000X | Y | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy |
No ID Information.