Healthcare Provider Details

I. General information

NPI: 1992344972
Provider Name (Legal Business Name): GAHC4 SACRAMENTO CA TRS SUB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2019
Last Update Date: 12/23/2019
Certification Date: 12/23/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1922 MORSE AVE
SACRAMENTO CA
95825-2136
US

IV. Provider business mailing address

1922 MORSE AVE
SACRAMENTO CA
95825-2136
US

V. Phone/Fax

Practice location:
  • Phone: 916-482-7745
  • Fax:
Mailing address:
  • Phone: 916-482-7745
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number
License Number State

VIII. Authorized Official

Name: MR. HENRY J VAUGHN
Title or Position: REIMBURSEMENT ANALYST
Credential:
Phone: 240-882-9712