MEDICARE: VACAVILLE SENIOR ASSISTED LIVING

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

General Provider Information

NPI Number	:	1821955600
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VACAVILLE SENIOR ASSISTED LIVING

Provider Business Mailing Address
First Line	:	4221 WILSHIRE BLVD STE 392
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90010-3537
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2061 PEABODY RD
Second Line	:
City	:	VACAVILLE
State	:	CA
Zip	:	95687-6291
Country	:	US
Telephone Number	:	707-452-3381
Fax Number	:	707-455-0330

Authorized Official
Title or Position	:	MANAGER
Name	:	STEVEN ATLAS
Credential	:
Telephone Number	:	707-452-3381

Provider Enumeration Date	:	01/05/2026
Last Update Date	:	01/05/2026

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