Healthcare Provider Details

I. General information

NPI: 1053311696
Provider Name (Legal Business Name): EASTER SEAL SOCIETY OF SUPERIOR CALIFORNIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2005
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9812 OLD WINERY PL STE 21
SACRAMENTO CA
95827-1732
US

IV. Provider business mailing address

9812 OLD WINERY PL STE 21
SACRAMENTO CA
95827-1732
US

V. Phone/Fax

Practice location:
  • Phone: 916-485-6711
  • Fax: 916-679-3100
Mailing address:
  • Phone: 916-485-6711
  • Fax: 916-679-3100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number StateNULL
# 4
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateNULL
# 6
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateNULL
# 7
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateNULL
# 8
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: RENNIE T SALTZMAN
Title or Position: VICE PRESIDENT, PEDIATRIC SERVICES
Credential:
Phone: 916-485-6711