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General NPI Number Information
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NPI Number | 1831243344
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Entity Type | Organization
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Legal Business Name | PARK SACRAMENTO ASSISTED LIVING LLC
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Dates
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Enumeration Date | 01/22/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1922 MORSE AVE
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City | SACRAMENTO
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State | CA
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Zip | 95825-2136
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Country | US
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Telephone | 916-482-7745
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Fax | 916-482-6245
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Provider Business Mailing Address
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Address Line | 1920 TIENDA DR STE 203
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City | LODI
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State | CA
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Zip | 95242-3930
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Country | US
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Telephone | 209-365-4020
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Fax | 209-367-4398
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | JOCELYN SANCHEZ
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Credential |
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Telephone | 209-365-4020
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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 | 3470000705
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License Number State | CA
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