Provider Demographics
NPI:1134620651
Name:INNOVATIVE DEVELOPMENT & LIVING SOLUTIONS OF CALIFORNIA
Entity type:Organization
Organization Name:INNOVATIVE DEVELOPMENT & LIVING SOLUTIONS OF CALIFORNIA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BOARD PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SIGALA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-266-6222
Mailing Address - Street 1:32 WEST SIERRA AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93612
Mailing Address - Country:US
Mailing Address - Phone:559-825-1735
Mailing Address - Fax:559-797-4464
Practice Address - Street 1:32 WEST SIERRA AVE
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93612
Practice Address - Country:US
Practice Address - Phone:559-825-1735
Practice Address - Fax:559-797-4464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-21
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA107208838310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility