MEDICARE: HOME CARE EL SHAMAH LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1003679044
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOME CARE EL SHAMAH LLC

Provider Business Mailing Address
First Line	:	7939 MARLA WAY
Second Line	:
City	:	ELK GROVE
State	:	CA
Zip	:	95758-7232
Country	:	US
Telephone Number	:	916-856-2749
Fax Number	:

Provider Business Practice Location Address
First Line	:	4991 44TH ST
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95820-5127
Country	:	US
Telephone Number	:	916-840-5530
Fax Number	:	916-840-5530

Authorized Official
Title or Position	:	CO OWNER
Name	:	BOLOU MATAMADURA
Credential	:
Telephone Number	:	916-856-2749

Provider Enumeration Date	:	02/02/2024
Last Update Date	:	02/02/2024

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