MEDICARE: CALI CARE RETIREMENT HOME 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	:	1720895493
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CALI CARE RETIREMENT HOME LLC

Provider Business Mailing Address
First Line	:	3630 WEST WAY
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95821-2704
Country	:	US
Telephone Number	:	916-664-3023
Fax Number	:	888-868-9747

Provider Business Practice Location Address
First Line	:	3630 WEST WAY
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95821-2704
Country	:	US
Telephone Number	:	916-664-3023
Fax Number	:	888-868-9747

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	CYNTHIA MOJICA
Credential	:
Telephone Number	:	916-289-4097

Provider Enumeration Date	:	12/16/2024
Last Update Date	:	12/16/2024

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