Healthcare Provider Details

I. General information

NPI: 1750244943
Provider Name (Legal Business Name): ABOVE AND BEYOND CONGREGATE LIVING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2025
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2027 BUR OAK PL
STOCKTON CA
95206-6386
US

IV. Provider business mailing address

231 MARKET PL STE 316
SAN RAMON CA
94583-4743
US

V. Phone/Fax

Practice location:
  • Phone: 209-918-7694
  • Fax:
Mailing address:
  • Phone: 209-918-7694
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MELISSA GENTILE
Title or Position: COO/OWNER
Credential:
Phone: 209-918-7694