Healthcare Provider Details

I. General information

NPI: 1174445076
Provider Name (Legal Business Name): LOPEZ CAREHOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10125 LAVELLI WAY
ELK GROVE CA
95757-4317
US

IV. Provider business mailing address

10125 LAVELLI WAY
ELK GROVE CA
95757-4317
US

V. Phone/Fax

Practice location:
  • Phone: 916-896-0917
  • Fax: 916-896-0917
Mailing address:
  • Phone: 916-896-0719
  • Fax: 916-896-0719

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376G00000X
TaxonomyNursing Home Administrator
License Number
License Number State

VIII. Authorized Official

Name: MR. ALBERT ALLAN UREA LOPEZ
Title or Position: OWNER
Credential:
Phone: 916-718-8189