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General NPI Number Information
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NPI Number | 1861993099
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Entity Type | Organization
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Legal Business Name | A SUMMERDALE HOMES @ RIBEIRO LLC
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Dates
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Enumeration Date | 02/22/2018
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Last Update Date | 02/22/2018
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Provider Practice Location Address
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Address Line | 1868 RIBEIRO CIR
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City | RENO
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State | NV
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Zip | 89503-4035
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Country | US
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Telephone | 775-746-1949
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Fax | 775-746-9244
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Provider Business Mailing Address
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Address Line | 1868 RIBEIRO CIR
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City | RENO
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State | NV
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Zip | 89503-4035
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Country | US
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Telephone | 775-746-1949
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Fax | 775-746-9244
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. EUGENE ROBLES GASATAYA
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Credential |
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Telephone | 310-855-4862
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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 | 2194-AGC-27
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License Number State | NV
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