=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679052849
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LAULELEI CARE SOLUTIONS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/09/2018
-----------------------------------------------------
Last Update Date | 08/09/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7551 SWEETFERN WAY
-----------------------------------------------------
City | SACRAMENTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95822-5726
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-271-6127
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 225 PENNSYLVANIA AVE APT C3
-----------------------------------------------------
City | FAIRFIELD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94533-6431
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-271-6127
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | PAULA ESEI UMUFUKE
-----------------------------------------------------
Credential | SUBLET
-----------------------------------------------------
Telephone | 916-271-6127
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3104A0625X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility (Mental Illness)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------