Provider Demographics
NPI:1427715341
Name:KENTFIELD ESTATES RANCH RCFE
Entity type:Organization
Organization Name:KENTFIELD ESTATES RANCH RCFE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARIAM
Authorized Official - Middle Name:GBATY
Authorized Official - Last Name:SOUMAHORO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-904-0027
Mailing Address - Street 1:3800 SILVER SPUR WAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95841-4411
Mailing Address - Country:US
Mailing Address - Phone:916-904-0027
Mailing Address - Fax:
Practice Address - Street 1:3800 SILVER SPUR WAY
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95841-4411
Practice Address - Country:US
Practice Address - Phone:916-904-0027
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-27
Last Update Date:2021-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility