Provider Demographics
NPI:1497435127
Name:JAZBA CARE TUOLUMNE
Entity Type:Organization
Organization Name:JAZBA CARE TUOLUMNE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LIENSEE
Authorized Official - Prefix:
Authorized Official - First Name:SHANE
Authorized Official - Middle Name:
Authorized Official - Last Name:STUMPF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-838-1457
Mailing Address - Street 1:9031 TUOLUMNE DR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95826-2429
Mailing Address - Country:US
Mailing Address - Phone:916-838-1457
Mailing Address - Fax:
Practice Address - Street 1:9031 TUOLUMNE DR
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95826-2429
Practice Address - Country:US
Practice Address - Phone:916-838-1457
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-18
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility