Provider Demographics
NPI:1508264755
Name:EDISON ESTATES LLC
Entity Type:Organization
Organization Name:EDISON ESTATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARY JANE
Authorized Official - Middle Name:
Authorized Official - Last Name:APUYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-275-6187
Mailing Address - Street 1:3741 EDISON AVE
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95821-2758
Mailing Address - Country:US
Mailing Address - Phone:916-484-7934
Mailing Address - Fax:
Practice Address - Street 1:3741 EDISON AVE
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95821-2758
Practice Address - Country:US
Practice Address - Phone:916-484-7934
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-19
Last Update Date:2014-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA347001881310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility