MEDICARE: ALISTER 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	314000000X	Skilled Nursing Facility

General Provider Information

NPI Number	:	1558082776
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALISTER LLC

Provider Business Mailing Address
First Line	:	2266 LAVA RIDGE CT
Second Line	:
City	:	ROSEVILLE
State	:	CA
Zip	:	95661-2856
Country	:	US
Telephone Number	:	949-508-8370
Fax Number	:

Provider Business Practice Location Address
First Line	:	415 P ST
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95814-5300
Country	:	US
Telephone Number	:	916-442-4906
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF OPERATIONS
Name	:	DAN BUSHNELL
Credential	:
Telephone Number	:	949-508-8370

Provider Enumeration Date	:	09/06/2022
Last Update Date	:	09/06/2022

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Directions to “ALISTER LLC ” Practice Location

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