Provider Demographics
NPI:1073251112
Name:YOUNG AT HEART RCFE NO 5 INC
Entity Type:Organization
Organization Name:YOUNG AT HEART RCFE NO 5 INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSEE
Authorized Official - Prefix:
Authorized Official - First Name:LILLIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SISAYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-320-4857
Mailing Address - Street 1:8039 CAYMUS DR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95829-1258
Mailing Address - Country:US
Mailing Address - Phone:916-681-3689
Mailing Address - Fax:
Practice Address - Street 1:8039 CAYMUS DR
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95829-1258
Practice Address - Country:US
Practice Address - Phone:916-681-3689
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-26
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility