Healthcare Provider Details

I. General information

NPI: 1306745336
Provider Name (Legal Business Name): PROVIDENCE ELDERLY SOLUTIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2026
Last Update Date: 11/04/2026
Certification Date: 11/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3136 GARFIELD AVE
CARMICHAEL CA
95608-3709
US

IV. Provider business mailing address

3136 GARFIELD AVE
CARMICHAEL CA
95608-3709
US

V. Phone/Fax

Practice location:
  • Phone: 279-345-0606
  • Fax:
Mailing address:
  • Phone:
  • 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: MARIA CELESTE DIMITIMAN
Title or Position: LICENSEE
Credential: BSN, RN
Phone: 916-690-0333