Provider Demographics
NPI:1033277355
Name:ETHELS DAUGHTER
Entity Type:Organization
Organization Name:ETHELS DAUGHTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADM OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OLLIE
Authorized Official - Middle Name:MAE
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-451-9809
Mailing Address - Street 1:3981 8TH AVE
Mailing Address - Street 2:ETHELS DAUGHTER
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817
Mailing Address - Country:US
Mailing Address - Phone:916-451-9809
Mailing Address - Fax:
Practice Address - Street 1:3981 8TH AVE
Practice Address - Street 2:ETHELS DAUGHTER
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817
Practice Address - Country:US
Practice Address - Phone:916-451-9809
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home