Provider Demographics
NPI:1083377436
Name:LILIBETH MEZA DBA SERRANO GUEST HOME 2
Entity Type:Organization
Organization Name:LILIBETH MEZA DBA SERRANO GUEST HOME 2
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LILIBETH
Authorized Official - Middle Name:
Authorized Official - Last Name:MEZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-661-2940
Mailing Address - Street 1:8774 KELSEY DR
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95624-1845
Mailing Address - Country:US
Mailing Address - Phone:916-661-2940
Mailing Address - Fax:
Practice Address - Street 1:8774 KELSEY DR
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95624-1845
Practice Address - Country:US
Practice Address - Phone:916-661-2940
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-21
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility