=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689531030
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LOVING ANGELS CAREHOME 2
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/07/2026
-----------------------------------------------------
Last Update Date | 01/07/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4722 HACKBERRY LN
-----------------------------------------------------
City | CARMICHAEL
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95608-2239
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-999-0931
-----------------------------------------------------
Fax | 916-993-6973
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4722 HACKBERRY LN
-----------------------------------------------------
City | CARMICHAEL
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95608-2239
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-999-0931
-----------------------------------------------------
Fax | 916-993-6973
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMISTRATOR
-----------------------------------------------------
Name | MIRASOL MUNGCAL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 916-346-7312
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------