MEDICARE: NORTHSTAR SENIOR LIVING, INC.

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	311500000X	Alzheimer Center (Dementia Center)
2	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1821819806
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHSTAR SENIOR LIVING, INC.

Provider Business Mailing Address
First Line	:	2334 WASHINGTON AVE
Second Line	:
City	:	REDDING
State	:	CA
Zip	:	96001-2159
Country	:	US
Telephone Number	:	530-242-8300
Fax Number	:	530-244-5555

Provider Business Practice Location Address
First Line	:	3420 R ST
Second Line	:
City	:	MERCED
State	:	CA
Zip	:	95348-2376
Country	:	US
Telephone Number	:	209-384-9700
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF COMPLIANCE
Name	:	TREVOR OGDEN
Credential	:
Telephone Number	:	530-242-8300

Provider Enumeration Date	:	10/22/2024
Last Update Date	:	10/22/2024

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