MEDICARE: MS CARMICHAEL SH, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1710627690
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MS CARMICHAEL SH, LLC

Provider Business Mailing Address
First Line	:	5451 FAIR OAKS BLVD
Second Line	:
City	:	CARMICHAEL
State	:	CA
Zip	:	95608-5748
Country	:	US
Telephone Number	:	916-485-4500
Fax Number	:	916-485-4544

Provider Business Practice Location Address
First Line	:	5451 FAIR OAKS BLVD
Second Line	:
City	:	CARMICHAEL
State	:	CA
Zip	:	95608-5748
Country	:	US
Telephone Number	:	916-485-4500
Fax Number	:	916-485-4544

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	DAVINA BARKER
Credential	:
Telephone Number	:	916-485-4500

Provider Enumeration Date	:	03/30/2022
Last Update Date	:	12/17/2024

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Directions to “MS CARMICHAEL SH, LLC ” Practice Location

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