Healthcare Provider Details

I. General information

NPI: 1104976794
Provider Name (Legal Business Name): ARYSA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2155 W. ELM ST.
LODI CA
95242
US

IV. Provider business mailing address

3432 GRANITE CT.
STOCKTON CA
95212
US

V. Phone/Fax

Practice location:
  • Phone: 209-333-1904
  • Fax: 209-368-2771
Mailing address:
  • Phone: 209-598-1186
  • Fax: 415-634-1755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License NumberLTC80160F
License Number StateCA

VIII. Authorized Official

Name: LUZ MARCOS
Title or Position: OWNER/LICENSEE/ ADMINISTRATOR
Credential:
Phone: 209-598-1186