Provider Demographics
NPI:1497550842
Name:CANTERBURY HOUSE
Entity type:Organization
Organization Name:CANTERBURY HOUSE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:YACUB
Authorized Official - Middle Name:
Authorized Official - Last Name:LUCAS
Authorized Official - Suffix:
Authorized Official - Credentials:ADMINISTRATOR
Authorized Official - Phone:916-997-9130
Mailing Address - Street 1:974 PARK RANCH WAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95831-3064
Mailing Address - Country:US
Mailing Address - Phone:916-997-9130
Mailing Address - Fax:916-515-8013
Practice Address - Street 1:2052 CANTERBURY RD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95815-3753
Practice Address - Country:US
Practice Address - Phone:916-395-1203
Practice Address - Fax:916-515-8013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-18
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility