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General NPI Number Information
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NPI Number | 1083979116
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Entity Type | Organization
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Legal Business Name | A COZY RETIREMENT HOME, LLC
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Dates
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Enumeration Date | 07/04/2012
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Last Update Date | 07/04/2012
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Provider Practice Location Address
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Address Line | 8781 KELSEY DR
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City | ELK GROVE
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State | CA
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Zip | 95624-1872
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Country | US
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Telephone | 916-502-3008
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Fax | 916-405-4212
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Provider Business Mailing Address
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Address Line | 8781 KELSEY DR
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City | ELK GROVE
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State | CA
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Zip | 95624-1872
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Country | US
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Telephone | 916-502-3008
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Fax | 916-405-4212
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Authorized Official
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Title or Position | MANAGER
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Name | GENEROSA C DIZON
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Credential | N/A
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Telephone | 916-502-3008
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 347004880
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License Number State | CA
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