Healthcare Provider Details

I. General information

NPI: 1548458235
Provider Name (Legal Business Name): ROSENWALD C. ROBERTSON ADULT DAY HEALTH CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2007
Last Update Date: 10/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 ELVAS AVE
SACRAMENTO CA
95819-1913
US

IV. Provider business mailing address

3400 ELVAS AVE
SACRAMENTO CA
95819-1913
US

V. Phone/Fax

Practice location:
  • Phone: 916-452-2529
  • Fax: 916-452-3129
Mailing address:
  • Phone: 916-452-2529
  • Fax: 916-452-3129

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number070000518
License Number StateCA

VIII. Authorized Official

Name: MR. JAMES P. MACDONALD
Title or Position: ADMINISTRATOR/PROGRAM DIRECTOR
Credential: MSDT, DPI
Phone: 916-452-2529