MEDICARE: MERLITA JAMES

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	376G00000X	Nursing Home Administrator

General Provider Information

NPI Number	:	1285151639
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MERLITA JAMES

Provider Business Mailing Address
First Line	:	8200 WOODED BROOK DR
Second Line	:
City	:	ELK GROVE
State	:	CA
Zip	:	95758
Country	:	US
Telephone Number	:	916-248-0652
Fax Number	:

Provider Business Practice Location Address
First Line	:	8200 WOODED BROOK DR
Second Line	:
City	:	ELK GROVE
State	:	CA
Zip	:	95758-8021
Country	:	US
Telephone Number	:	916-248-0652
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/26/2017
Last Update Date	:	07/21/2022

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