Provider Demographics
NPI:1609089630
Name:NORTHERN CALIFORNIA ADAPTIVE LIVING CENTER, INC.
Entity Type:Organization
Organization Name:NORTHERN CALIFORNIA ADAPTIVE LIVING CENTER, INC.
Other - Org Name:MOUNTAINVIEW FACILITY
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:KOLAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-894-2726
Mailing Address - Street 1:3028 ESPLANADE
Mailing Address - Street 2:SUITE H
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95973-4924
Mailing Address - Country:US
Mailing Address - Phone:530-894-2726
Mailing Address - Fax:530-894-2798
Practice Address - Street 1:1000 SANFORD RANCH RD
Practice Address - Street 2:
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482-5241
Practice Address - Country:US
Practice Address - Phone:707-468-9331
Practice Address - Fax:707-468-9007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALTC60313GOtherMEDI-CAL