Provider Demographics
NPI:1568179091
Name:GRANNY'S COTTAGE
Entity Type:Organization
Organization Name:GRANNY'S COTTAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ADALBERTH
Authorized Official - Middle Name:SABINEL
Authorized Official - Last Name:BANCU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-606-9670
Mailing Address - Street 1:7717 DEANTON CT
Mailing Address - Street 2:
Mailing Address - City:CITRUS HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:95610-2131
Mailing Address - Country:US
Mailing Address - Phone:916-606-9670
Mailing Address - Fax:916-729-9319
Practice Address - Street 1:7717 DEANTON CT
Practice Address - Street 2:
Practice Address - City:CITRUS HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:95610-2131
Practice Address - Country:US
Practice Address - Phone:916-606-9670
Practice Address - Fax:916-729-9319
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-03
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility