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General NPI Number Information
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NPI Number | 1235789462
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Entity Type | Organization
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Legal Business Name | SIERRA CARE AT THE LAKE,LLC
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Dates
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Enumeration Date | 09/19/2019
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Last Update Date | 09/19/2019
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Provider Practice Location Address
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Address Line | 33425 GLOBE DR
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City | SPRINGVILLE
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State | CA
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Zip | 93265
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Country | US
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Telephone | 559-539-2727
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Fax | 559-553-8840
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Provider Business Mailing Address
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Address Line | 33425 GLOBE DR
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City | SPRINGVILLE
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State | CA
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Zip | 93265
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Country | US
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Telephone | 559-539-2727
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Fax | 559-553-8840
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Authorized Official
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Title or Position | PRESIDENT
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Name | GARY ANDREW PONTICIELLO
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Credential |
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Telephone | 559-539-2727
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 315D00000X
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Taxonomy Name | Inpatient Hospice
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 311Z00000X
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Taxonomy Name | Custodial Care Facility
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number |
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License Number State |
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