Provider Demographics
NPI:1487641452
Name:ASIAN COMMUNITY CENTER OF SACRAMENTO VALLEY INC
Entity Type:Organization
Organization Name:ASIAN COMMUNITY CENTER OF SACRAMENTO VALLEY INC
Other - Org Name:ASIAN COMMUNITY NURSING HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DARREN
Authorized Official - Middle Name:
Authorized Official - Last Name:TRISEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-393-9020
Mailing Address - Street 1:7801 RUSH RIVER DR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95831-4602
Mailing Address - Country:US
Mailing Address - Phone:916-393-9020
Mailing Address - Fax:916-393-9025
Practice Address - Street 1:7801 RUSH RIVER DR
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95831-4602
Practice Address - Country:US
Practice Address - Phone:916-393-9020
Practice Address - Fax:916-393-9025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALTC55261FMedicaid
CA555261Medicare ID - Type Unspecified