=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982485629
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RC VILLAS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/09/2023
-----------------------------------------------------
Last Update Date | 03/13/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8134 ROBERT CREEK CT
-----------------------------------------------------
City | CITRUS HEIGHTS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95610-0801
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-858-9780
-----------------------------------------------------
Fax | 916-357-9758
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 668 ATHERTON WAY
-----------------------------------------------------
City | PLUMAS LAKE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95961-8914
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-858-9780
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/MANAGER
-----------------------------------------------------
Name | ROBERT KING
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 916-858-9780
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 311ZA0620X
-----------------------------------------------------
Taxonomy Name | Adult Care Home Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------