Provider Demographics
NPI:1689672578
Name:ABCD ASSOCIATES
Entity Type:Organization
Organization Name:ABCD ASSOCIATES
Other - Org Name:DBA CASA COLOMA HEALTH CARE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:PORTELA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-363-4843
Mailing Address - Street 1:10410 COLOMA RD
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-2108
Mailing Address - Country:US
Mailing Address - Phone:916-363-4843
Mailing Address - Fax:916-363-4316
Practice Address - Street 1:10410 COLOMA RD
Practice Address - Street 2:
Practice Address - City:RANCHO CORDOVA
Practice Address - State:CA
Practice Address - Zip Code:95670-2108
Practice Address - Country:US
Practice Address - Phone:916-363-4843
Practice Address - Fax:916-363-4316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-13
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1000001314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZR06495GMedicaid
CA056495Medicare ID - Type Unspecified