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General NPI Number Information
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NPI Number | 1073921250
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Entity Type | Organization
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Legal Business Name | YOUNG AT HEART RCFE
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Dates
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Enumeration Date | 07/31/2014
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Last Update Date | 07/31/2014
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Provider Practice Location Address
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Address Line | 9882 CORTINO WAY
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City | ELK GROVE
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State | CA
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Zip | 95757-3049
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Country | US
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Telephone | 916-686-8822
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Fax | 916-686-5515
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Provider Business Mailing Address
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Address Line | 9882 CORTINO WAY
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City | ELK GROVE
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State | CA
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Zip | 95757-3049
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Country | US
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Telephone | 916-686-8822
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Fax | 916-686-5515
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Authorized Official
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Title or Position | CEO
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Name | LILLIAN SISAYAN
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Credential | R.N., BSN
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Telephone | 916-320-4857
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320700000X
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Taxonomy Name | Physical Disabilities Residential Treatment Facility
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License Number | 347001885
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License Number State | CA
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