Provider Demographics
NPI:1013183581
Name:ARYSA, LLC
Entity type:Organization
Organization Name:ARYSA, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/LICENSEE/ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LUZ
Authorized Official - Middle Name:
Authorized Official - Last Name:MARCOS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:209-598-1186
Mailing Address - Street 1:3432 GRANITE CT.
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95212
Mailing Address - Country:US
Mailing Address - Phone:209-598-1186
Mailing Address - Fax:415-634-1755
Practice Address - Street 1:2216 ALPINE DRIVE
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95240-7223
Practice Address - Country:US
Practice Address - Phone:209-333-0592
Practice Address - Fax:209-368-2771
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GABRIEL CARE HOME INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-05-05
Last Update Date:2025-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALTC80271F315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities