Healthcare Provider Details

I. General information

NPI: 1053275701
Provider Name (Legal Business Name): KINDRED RESIDENTIAL CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 SHADY LAKE CT
SACRAMENTO CA
95834-1516
US

IV. Provider business mailing address

26 SHADY LAKE CT
SACRAMENTO CA
95834-1516
US

V. Phone/Fax

Practice location:
  • Phone: 949-241-0674
  • Fax:
Mailing address:
  • Phone: 949-241-0674
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: SHEILA MARIE LAMOUR OCO
Title or Position: ADMINISTRATOR
Credential:
Phone: 949-241-0674