=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831904705
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SACRAMENTO BASED ADULT DAY SERVICE INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/10/2025
-----------------------------------------------------
Last Update Date | 02/10/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1550 STEINER ST
-----------------------------------------------------
City | SAN FRANCISCO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94115-3526
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-963-4802
-----------------------------------------------------
Fax | 415-839-9564
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 620 BERCUT DR BERCUT
-----------------------------------------------------
City | SACRAMENTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95811
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-414-4530
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CONSULTANT
-----------------------------------------------------
Name | CYNTHIA SUNDBERG
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 916-444-7700
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA0600X
-----------------------------------------------------
Taxonomy Name | Adult Day Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------