Provider Demographics
NPI:1073921250
Name:YOUNG AT HEART RCFE
Entity Type:Organization
Organization Name:YOUNG AT HEART RCFE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LILLIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SISAYAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:916-320-4857
Mailing Address - Street 1:9882 CORTINO WAY
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95757-3049
Mailing Address - Country:US
Mailing Address - Phone:916-686-8822
Mailing Address - Fax:916-686-5515
Practice Address - Street 1:9882 CORTINO WAY
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95757-3049
Practice Address - Country:US
Practice Address - Phone:916-686-8822
Practice Address - Fax:916-686-5515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-31
Last Update Date:2014-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA347001885320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities