MEDICARE: ABOVE AND BEYOND SEN IOR CARE 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	302R00000X	Health Maintenance Organization	1004707	CA

General Provider Information

NPI Number	:	1558642447
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ABOVE AND BEYOND SEN IOR CARE LLC

Provider Business Mailing Address
First Line	:	2842 TOURBROOK WAY
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95833
Country	:	US
Telephone Number	:	916-233-6790
Fax Number	:

Provider Business Practice Location Address
First Line	:	2842 TOURBROOK WAY
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95833-4416
Country	:	US
Telephone Number	:	916-233-6790
Fax Number	:

Authorized Official
Title or Position	:	PROGRAM DIRECTOR
Name	:	MS. IRMA ROSSMAN
Credential	:
Telephone Number	:	916-233-6790

Provider Enumeration Date	:	09/06/2011
Last Update Date	:	09/06/2011

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