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General NPI Number Information
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NPI Number | 1497550842
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Entity Type | Organization
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Legal Business Name | CANTERBURY HOUSE
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Dates
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Enumeration Date | 02/18/2025
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Last Update Date | 02/18/2025
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Provider Practice Location Address
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Address Line | 2052 CANTERBURY RD
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City | SACRAMENTO
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State | CA
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Zip | 95815-3753
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Country | US
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Telephone | 916-395-1203
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Fax | 916-515-8013
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Provider Business Mailing Address
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Address Line | 974 PARK RANCH WAY
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City | SACRAMENTO
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State | CA
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Zip | 95831-3064
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Country | US
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Telephone | 916-997-9130
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Fax | 916-515-8013
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Authorized Official
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Title or Position | OWNER
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Name | MR. YACUB LUCAS
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Credential | ADMINISTRATOR
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Telephone | 916-997-9130
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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 |
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License Number State |
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