Healthcare Provider Details

I. General information

NPI: 1851123889
Provider Name (Legal Business Name): KOFFLER PROPERTIES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2024
Last Update Date: 08/19/2024
Certification Date: 08/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3722 43RD ST
SACRAMENTO CA
95820-1319
US

IV. Provider business mailing address

3104 O ST # 143
SACRAMENTO CA
95816-6519
US

V. Phone/Fax

Practice location:
  • Phone: 760-889-2571
  • Fax:
Mailing address:
  • Phone: 760-889-2571
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: KADEN KOFFLER
Title or Position: OWNER / MANAGING MEMBER
Credential: MSC
Phone: 760-889-2571