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General NPI Number Information
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NPI Number | 1104976794
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Entity Type | Organization
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Legal Business Name | ARYSA, LLC
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Dates
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Enumeration Date | 01/12/2007
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Last Update Date | 12/16/2025
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Provider Practice Location Address
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Address Line | 2155 W. ELM ST.
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City | LODI
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State | CA
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Zip | 95242
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Country | US
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Telephone | 209-333-1904
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Fax | 209-368-2771
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Provider Business Mailing Address
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Address Line | 3432 GRANITE CT.
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City | STOCKTON
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State | CA
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Zip | 95212
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Country | US
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Telephone | 209-598-1186
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Fax | 415-634-1755
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Authorized Official
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Title or Position | OWNER/LICENSEE/ ADMINISTRATOR
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Name | LUZ MARCOS
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Credential |
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Telephone | 209-598-1186
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 315P00000X
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Taxonomy Name | Intellectual Disabilities Intermediate Care Facility
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License Number | LTC80160F
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License Number State | CA
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