Healthcare Provider Details

I. General information

NPI: 1184198970
Provider Name (Legal Business Name): AG MAR INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2019
Last Update Date: 01/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10086 MILLS STATION RD
SACRAMENTO CA
95827-2204
US

IV. Provider business mailing address

10086 MILLS STATION RD
SACRAMENTO CA
95827-2204
US

V. Phone/Fax

Practice location:
  • Phone: 916-369-1113
  • Fax: 916-369-3763
Mailing address:
  • Phone: 916-369-1113
  • Fax: 916-369-3763

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SALLY MARANA
Title or Position: CEO
Credential:
Phone: 916-396-8111