Provider Demographics
NPI:1114463163
Name:MOTHER VIRGINIA LOVING CARE, INC
Entity Type:Organization
Organization Name:MOTHER VIRGINIA LOVING CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RCFE ADMINISTRATOR, PRESIDENT,OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JCTHY WISDOM
Authorized Official - Middle Name:M
Authorized Official - Last Name:OBTINALLA
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:916-801-8917
Mailing Address - Street 1:10949 HAVESHILL WAY
Mailing Address - Street 2:
Mailing Address - City:MATHER
Mailing Address - State:CA
Mailing Address - Zip Code:95655-3073
Mailing Address - Country:US
Mailing Address - Phone:916-801-8917
Mailing Address - Fax:
Practice Address - Street 1:9847 LINCOLN VILLAGE DR
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95827-3401
Practice Address - Country:US
Practice Address - Phone:916-801-8917
Practice Address - Fax:916-476-3622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-16
Last Update Date:2017-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA347005727310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility