Provider Demographics
NPI:1205109097
Name:CITRUS HEIGHTS TERRACE
Entity type:Organization
Organization Name:CITRUS HEIGHTS TERRACE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:EBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-727-4400
Mailing Address - Street 1:7952 OLD AUBURN RD
Mailing Address - Street 2:
Mailing Address - City:CITRUS HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:95610-2433
Mailing Address - Country:US
Mailing Address - Phone:916-727-4400
Mailing Address - Fax:916-727-4232
Practice Address - Street 1:7952 OLD AUBURN RD
Practice Address - Street 2:
Practice Address - City:CITRUS HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:95610-2433
Practice Address - Country:US
Practice Address - Phone:916-727-4400
Practice Address - Fax:916-727-4232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-09
Last Update Date:2014-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA347001498310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility