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General NPI Number Information
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NPI Number | 1902028319
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Entity Type | Organization
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Legal Business Name | SUN GARDEN REST HOME
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3444 ELMER AVE
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City | YUBA CITY
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State | CA
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Zip | 95993-9605
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Country | US
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Telephone | 530-671-1280
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Fax | 530-671-1280
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Provider Business Mailing Address
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Address Line | 3444 ELMER AVE
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City | YUBA CITY
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State | CA
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Zip | 95993-9605
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Country | US
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Telephone | 530-671-1280
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Fax | 530-671-1280
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. TINA MARIE JORDAN-TRAINQUE
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Credential |
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Telephone | 530-671-1280
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number |
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License Number State | CA
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