Healthcare Provider Details

I. General information

NPI: 1417932724
Provider Name (Legal Business Name): CARMICHAEL CARE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2005
Last Update Date: 10/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6041 FAIR OAKS BLVD
CARMICHAEL CA
95608-4816
US

IV. Provider business mailing address

6041 FAIR OAKS BLVD
CARMICHAEL CA
95608-4816
US

V. Phone/Fax

Practice location:
  • Phone: 916-483-8103
  • Fax:
Mailing address:
  • Phone: 916-483-8103
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number030000177
License Number StateCA

VIII. Authorized Official

Name: SPENCER OLSEN
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 949-240-2423