Healthcare Provider Details

I. General information

NPI: 1053684811
Provider Name (Legal Business Name): COURTYARD TERRACE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2012
Last Update Date: 01/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3408 ALTA ARDEN EXPY
SACRAMENTO CA
95825-2103
US

IV. Provider business mailing address

3408 ALTA ARDEN EXPY
SACRAMENTO CA
95825-2103
US

V. Phone/Fax

Practice location:
  • Phone: 916-486-1281
  • Fax: 916-486-1282
Mailing address:
  • Phone: 916-486-1281
  • Fax: 916-486-1282

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number347001078
License Number StateCA

VIII. Authorized Official

Name: ADINA VARAREANU
Title or Position: ADMINISTRATOR
Credential:
Phone: 916-704-0328