Provider Demographics
NPI:1083979116
Name:A COZY RETIREMENT HOME, LLC
Entity Type:Organization
Organization Name:A COZY RETIREMENT HOME, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GENEROSA
Authorized Official - Middle Name:C
Authorized Official - Last Name:DIZON
Authorized Official - Suffix:
Authorized Official - Credentials:N/A
Authorized Official - Phone:916-502-3008
Mailing Address - Street 1:8781 KELSEY DR
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95624-1872
Mailing Address - Country:US
Mailing Address - Phone:916-502-3008
Mailing Address - Fax:916-405-4212
Practice Address - Street 1:8781 KELSEY DR
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95624-1872
Practice Address - Country:US
Practice Address - Phone:916-502-3008
Practice Address - Fax:916-405-4212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-04
Last Update Date:2012-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA347004880310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility