Healthcare Provider Details

I. General information

NPI: 1316719909
Provider Name (Legal Business Name): SBSG EQUITY GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2023
Last Update Date: 10/26/2023
Certification Date: 10/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 MELODY LN STE 1040
ROSEVILLE CA
95678-5203
US

IV. Provider business mailing address

1100 MELODY LN STE 1040
ROSEVILLE CA
95678-5203
US

V. Phone/Fax

Practice location:
  • Phone: 916-794-2288
  • Fax:
Mailing address:
  • Phone: 916-794-2288
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: SHAUN GERONIMO
Title or Position: CEO/PRESIDENT
Credential:
Phone: 808-258-6467