MEDICARE: WOODLAND GARDENS SENIOR LIVING 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	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1841172798
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WOODLAND GARDENS SENIOR LIVING LLC

Provider Business Mailing Address
First Line	:	7920 ALTA SUNRISE DR STE 250
Second Line	:
City	:	CITRUS HEIGHTS
State	:	CA
Zip	:	95610-7963
Country	:	US
Telephone Number	:	916-486-9639
Fax Number	:

Provider Business Practice Location Address
First Line	:	240 PALM AVE
Second Line	:
City	:	WOODLAND
State	:	CA
Zip	:	95695-2844
Country	:	US
Telephone Number	:	530-661-0574
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MARK J CIMINO SR.
Credential	:
Telephone Number	:	916-704-6275

Provider Enumeration Date	:	07/22/2025
Last Update Date	:	07/22/2025

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