Provider Demographics
NPI:1043393713
Name:SANDY'S GUEST HOME
Entity Type:Organization
Organization Name:SANDY'S GUEST HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:TATEISHI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-451-5489
Mailing Address - Street 1:4991 44TH ST
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95820-5127
Mailing Address - Country:US
Mailing Address - Phone:916-451-5489
Mailing Address - Fax:
Practice Address - Street 1:4991 44TH ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95820-5127
Practice Address - Country:US
Practice Address - Phone:916-451-5489
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA340310942311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home