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General NPI Number Information
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NPI Number | 1114463163
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Entity Type | Organization
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Legal Business Name | MOTHER VIRGINIA LOVING CARE, INC
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Dates
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Enumeration Date | 01/16/2017
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Last Update Date | 01/16/2017
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Provider Practice Location Address
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Address Line | 9847 LINCOLN VILLAGE DR
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City | SACRAMENTO
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State | CA
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Zip | 95827-3401
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Country | US
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Telephone | 916-801-8917
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Fax | 916-476-3622
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Provider Business Mailing Address
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Address Line | 10949 HAVESHILL WAY
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City | MATHER
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State | CA
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Zip | 95655-3073
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Country | US
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Telephone | 916-801-8917
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Fax |
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Authorized Official
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Title or Position | RCFE ADMINISTRATOR, PRESIDENT,OWNER
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Name | MR. JCTHY WISDOM M OBTINALLA
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Credential | REGISTERED NURSE
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Telephone | 916-801-8917
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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 | 347005727
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License Number State | CA
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