=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851254080
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SALUTARIS CARE HOME LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/04/2025
-----------------------------------------------------
Last Update Date | 12/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2711 MAYBROOK DR
-----------------------------------------------------
City | SACRAMENTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95835-1598
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-745-9311
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2711 MAYBROOK DR
-----------------------------------------------------
City | SACRAMENTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95835-1598
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-745-9311
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR/OWNER
-----------------------------------------------------
Name | MS. GEORGINA CHIGOZIE IGWEGBE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 916-745-9311
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 311ZA0620X
-----------------------------------------------------
Taxonomy Name | Adult Care Home Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------