Healthcare Provider Details

I. General information

NPI: 1083754253
Provider Name (Legal Business Name): WALNUT HOUSE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 WALNUT AVE
CARMICHAEL CA
95608-3241
US

IV. Provider business mailing address

3401 WALNUT AVE
CARMICHAEL CA
95608-3241
US

V. Phone/Fax

Practice location:
  • Phone: 916-483-6612
  • Fax: 916-483-7134
Mailing address:
  • Phone: 916-483-6612
  • Fax: 916-483-7134

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. STUART M DRAKE
Title or Position: EXEC. ADMINISTRATOR
Credential:
Phone: 916-483-6612