MEDICARE: PEACEFUL PLACE AT POCKET INC

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	:	1902644255
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEACEFUL PLACE AT POCKET INC

Provider Business Mailing Address
First Line	:	865 ROYAL GREEN AVE
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95831-1518
Country	:	US
Telephone Number	:	916-549-2724
Fax Number	:	916-829-2737

Provider Business Practice Location Address
First Line	:	865 ROYAL GREEN AVE
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95831-1518
Country	:	US
Telephone Number	:	916-549-2724
Fax Number	:	916-829-2737

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ANTONETTE TIN
Credential	:
Telephone Number	:	916-549-2724

Provider Enumeration Date	:	07/19/2024
Last Update Date	:	07/19/2024

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Directions to “PEACEFUL PLACE AT POCKET INC ” Practice Location

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