Healthcare Provider Details

I. General information

NPI: 1558642447
Provider Name (Legal Business Name): ABOVE AND BEYOND SEN IOR CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2011
Last Update Date: 09/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2842 TOURBROOK WAY
SACRAMENTO CA
95833-4416
US

IV. Provider business mailing address

2842 TOURBROOK WAY
SACRAMENTO CA
95833
US

V. Phone/Fax

Practice location:
  • Phone: 916-233-6790
  • Fax:
Mailing address:
  • Phone: 916-233-6790
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number1004707
License Number StateCA

VIII. Authorized Official

Name: MS. IRMA ROSSMAN
Title or Position: PROGRAM DIRECTOR
Credential:
Phone: 916-233-6790