Provider Demographics
NPI:1679650253
Name:ST. MARY'S HOME
Entity Type:Organization
Organization Name:ST. MARY'S HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSEE, ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARMELITA
Authorized Official - Middle Name:P
Authorized Official - Last Name:SANTOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-929-6951
Mailing Address - Street 1:1347 BELL STREET
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825
Mailing Address - Country:US
Mailing Address - Phone:916-929-6951
Mailing Address - Fax:
Practice Address - Street 1:1347 BELL ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-2301
Practice Address - Country:US
Practice Address - Phone:916-929-6951
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home