Healthcare Provider Details

I. General information

NPI: 1023702693
Provider Name (Legal Business Name): LITTLE BROOK CARE HOME 1
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2023
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8832 FAIR OAKS BLVD
CARMICHAEL CA
95608-2612
US

IV. Provider business mailing address

8832 FAIR OAKS BLVD
CARMICHAEL CA
95608-2612
US

V. Phone/Fax

Practice location:
  • Phone: 916-500-4512
  • Fax:
Mailing address:
  • Phone: 916-500-4512
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: PERSIDA POP
Title or Position: MANAGING DIRECTOR
Credential:
Phone: 916-500-4512