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General NPI Number Information
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NPI Number | 1962749333
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Entity Type | Organization
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Legal Business Name | WOOD'S RETREAT
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Dates
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Enumeration Date | 01/05/2013
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Last Update Date | 01/05/2013
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Provider Practice Location Address
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Address Line | 7415 HENRIETTA DR
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City | SACRAMENTO
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State | CA
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Zip | 95822-5142
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Country | US
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Telephone | 916-421-5845
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Fax | 916-880-5451
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Provider Business Mailing Address
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Address Line | 7415 HENRIETTA DR
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City | SACRAMENTO
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State | CA
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Zip | 95822-5142
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Country | US
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Telephone | 916-421-5845
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Fax | 916-880-5451
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Authorized Official
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Title or Position | GENERAL PARTNER
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Name | MRS. REMA P STOUT
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Credential |
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Telephone | 916-421-5845
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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 | 340306720
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License Number State | CA
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