Provider Demographics
NPI:1164197000
Name:WHOLESOME ELDERLY CARE HOMES, LLC
Entity Type:Organization
Organization Name:WHOLESOME ELDERLY CARE HOMES, LLC
Other - Org Name:WHOLESOME ELDERLY ON KIFSIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING-MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:FAAMAUSILI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-970-2647
Mailing Address - Street 1:3501 BROADMOOR WAY
Mailing Address - Street 2:
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-3423
Mailing Address - Country:US
Mailing Address - Phone:916-670-2647
Mailing Address - Fax:
Practice Address - Street 1:6024 KIFISIA WAY
Practice Address - Street 2:
Practice Address - City:FAIR OAKS
Practice Address - State:CA
Practice Address - Zip Code:95628-2520
Practice Address - Country:US
Practice Address - Phone:714-678-0268
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-12
Last Update Date:2023-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility