Provider Demographics
NPI:1053684811
Name:COURTYARD TERRACE
Entity Type:Organization
Organization Name:COURTYARD TERRACE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ADINA
Authorized Official - Middle Name:
Authorized Official - Last Name:VARAREANU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-704-0328
Mailing Address - Street 1:3408 ALTA ARDEN EXPY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-2103
Mailing Address - Country:US
Mailing Address - Phone:916-486-1281
Mailing Address - Fax:916-486-1282
Practice Address - Street 1:3408 ALTA ARDEN EXPY
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-2103
Practice Address - Country:US
Practice Address - Phone:916-486-1281
Practice Address - Fax:916-486-1282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-09
Last Update Date:2014-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA347001078310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility