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General NPI Number Information
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NPI Number | 1508264755
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Entity Type | Organization
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Legal Business Name | EDISON ESTATES LLC
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Dates
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Enumeration Date | 12/19/2014
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Last Update Date | 12/19/2014
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Provider Practice Location Address
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Address Line | 3741 EDISON AVE
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City | SACRAMENTO
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State | CA
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Zip | 95821-2758
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Country | US
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Telephone | 916-484-7934
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Fax |
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Provider Business Mailing Address
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Address Line | 3741 EDISON AVE
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City | SACRAMENTO
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State | CA
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Zip | 95821-2758
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Country | US
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Telephone | 916-484-7934
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MARY JANE APUYA
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Credential |
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Telephone | 916-275-6187
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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 | 347001881
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License Number State | CA
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