Provider Demographics
NPI:1457832230
Name:SOLAR SENIOR LIVING LLC
Entity Type:Organization
Organization Name:SOLAR SENIOR LIVING LLC
Other - Org Name:WALNUT HOUSE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:SILVERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-789-8858
Mailing Address - Street 1:22 MARINERO CIR APT 59
Mailing Address - Street 2:
Mailing Address - City:TIBURON
Mailing Address - State:CA
Mailing Address - Zip Code:94920-1621
Mailing Address - Country:US
Mailing Address - Phone:415-789-8858
Mailing Address - Fax:
Practice Address - Street 1:3401 WALNUT AVE
Practice Address - Street 2:
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-3241
Practice Address - Country:US
Practice Address - Phone:916-483-6651
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-28
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA342700186310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA342700186OtherCALIFORNIA DEPARTMENT OF SOCIAL SERVICES