Provider Demographics
NPI:1578044350
Name:SOLAR SENIOR LIVING 2 LLC
Entity Type:Organization
Organization Name:SOLAR SENIOR LIVING 2 LLC
Other - Org Name:COUNTRY CLUB MANOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:SILVERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-789-8858
Mailing Address - Street 1:22 MARINERO CIR APT 59
Mailing Address - Street 2:
Mailing Address - City:TIBURON
Mailing Address - State:CA
Mailing Address - Zip Code:94920-1621
Mailing Address - Country:US
Mailing Address - Phone:414-789-8858
Mailing Address - Fax:
Practice Address - Street 1:2100 BUTANO DR
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-0448
Practice Address - Country:US
Practice Address - Phone:916-481-9240
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-28
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA342700301310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility