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General NPI Number Information
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NPI Number | 1164120390
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Entity Type | Organization
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Legal Business Name | VALLONE TRISTAN CIRCLE LLC
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Dates
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Enumeration Date | 02/17/2023
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Last Update Date | 02/17/2023
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Provider Practice Location Address
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Address Line | 96 TRISTAN CIR
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City | SACRAMENTO
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State | CA
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Zip | 95823-4145
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Country | US
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Telephone | 916-392-1968
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2944
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City | MERCED
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State | CA
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Zip | 95344-0944
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | GODWIN AKA
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Credential |
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Telephone | 916-225-0349
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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 |
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License Number State |
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