Provider Demographics
NPI:1497158695
Name:YOUNG AT HEART RCFE NO. 5
Entity Type:Organization
Organization Name:YOUNG AT HEART RCFE NO. 5
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LILLIAN
Authorized Official - Middle Name:T
Authorized Official - Last Name:SISAYAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:916-686-8822
Mailing Address - Street 1:9882 CORTINO WAY
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95757-3049
Mailing Address - Country:US
Mailing Address - Phone:916-686-8822
Mailing Address - Fax:916-686-5515
Practice Address - Street 1:8039 CAYMUS DR
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95829-1258
Practice Address - Country:US
Practice Address - Phone:916-689-8882
Practice Address - Fax:916-689-8882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-01
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA347004226311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home