MEDICARE: ASSISTED LIVING THERAPIES

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	OT4110	CA

General Provider Information

NPI Number	:	1285735084
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASSISTED LIVING THERAPIES

Provider Business Mailing Address
First Line	:	3657 BLUEBERRY HILL DR
Second Line	:
City	:	SHINGLE SPRINGS
State	:	CA
Zip	:	95682-8885
Country	:	US
Telephone Number	:	530-677-5294
Fax Number	:	530-677-5294

Provider Business Practice Location Address
First Line	:	3657 BLUEBERRY HILL DR
Second Line	:
City	:	SHINGLE SPRINGS
State	:	CA
Zip	:	95682-8885
Country	:	US
Telephone Number	:	530-677-5294
Fax Number	:	530-677-5294

Authorized Official
Title or Position	:	OWNER/OCCUPATIONAL THERAPIST
Name	:	MRS. ELIZABETH ANNA ZIMMERMAN
Credential	:	MSOTR
Telephone Number	:	530-677-5294

Provider Enumeration Date	:	09/26/2006
Last Update Date	:	08/22/2020

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