Healthcare Provider Details

I. General information

NPI: 1649536061
Provider Name (Legal Business Name): UNITED CARE RESIDENTIAL HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2012
Last Update Date: 04/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47 DECATHLON CIR
SACRAMENTO CA
95823-4076
US

IV. Provider business mailing address

47 DECATHLON CIR
SACRAMENTO CA
95823-4076
US

V. Phone/Fax

Practice location:
  • Phone: 916-421-4778
  • Fax:
Mailing address:
  • Phone: 916-421-4778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number347004338
License Number StateCA

VIII. Authorized Official

Name: MS. JULIEBETH B ARZADON
Title or Position: LICENSEE/ADMINISTRATOR
Credential:
Phone: 916-421-4778