Provider Demographics
NPI:1578066585
Name:COSL SACRAMENTO, LP
Entity Type:Organization
Organization Name:COSL SACRAMENTO, LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CARL
Authorized Official - Middle Name:
Authorized Official - Last Name:MITTENDORFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-780-8100
Mailing Address - Street 1:1922 MORSE AVE
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-2136
Mailing Address - Country:US
Mailing Address - Phone:916-482-7745
Mailing Address - Fax:916-482-6245
Practice Address - Street 1:1922 MORSE AVE
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-2136
Practice Address - Country:US
Practice Address - Phone:916-482-7745
Practice Address - Fax:916-482-6245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-15
Last Update Date:2018-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility