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General NPI Number Information
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NPI Number | 1700335692
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Entity Type | Organization
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Legal Business Name | 77 ASSISTED LIVING
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Dates
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Enumeration Date | 10/03/2016
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Last Update Date | 03/09/2017
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Provider Practice Location Address
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Address Line | 7730 LORIN AVE
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City | SACRAMENTO
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State | CA
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Zip | 95828-3133
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Country | US
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Telephone | 916-388-8328
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Fax | 916-387-0418
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Provider Business Mailing Address
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Address Line | 7730 LORIN AVE
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City | SACRAMENTO
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State | CA
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Zip | 95828-3133
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Country | US
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Telephone | 916-388-8328
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Fax | 916-387-0418
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | RUDI WU
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Credential |
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Telephone | 916-388-8328
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number | 347005362
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License Number State | CA
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