MEDICARE: ANGELS HOME FOR SENIORS 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	311ZA0620X	Adult Care Home Facility

General Provider Information

NPI Number	:	1326964917
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANGELS HOME FOR SENIORS LLC

Provider Business Mailing Address
First Line	:	10070 KNOTTS DR
Second Line	:
City	:	ELK GROVE
State	:	CA
Zip	:	95757-1729
Country	:	US
Telephone Number	:	916-895-2890
Fax Number	:

Provider Business Practice Location Address
First Line	:	10070 KNOTTS DR
Second Line	:
City	:	ELK GROVE
State	:	CA
Zip	:	95757-1729
Country	:	US
Telephone Number	:	916-895-2890
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. DEANE JEFFREY DEJARESCO
Credential	:
Telephone Number	:	916-620-6235

Provider Enumeration Date	:	06/26/2026
Last Update Date	:	06/26/2026

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Directions to “ANGELS HOME FOR SENIORS LLC ” Practice Location

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