Healthcare Provider Details

I. General information

NPI: 1750106647
Provider Name (Legal Business Name): LEXINGTON HILLS SENIOR CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2024
Last Update Date: 11/18/2024
Certification Date: 11/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

164 BISCAYNE WAY
FOLSOM CA
95630-6757
US

IV. Provider business mailing address

164 BISCAYNE WAY
FOLSOM CA
95630-6757
US

V. Phone/Fax

Practice location:
  • Phone: 916-225-5204
  • Fax:
Mailing address:
  • Phone: 916-225-5204
  • 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: ROMELIA HORJA
Title or Position: LICENSEE
Credential:
Phone: 916-225-5204