Provider Demographics
NPI:1770940033
Name:SUMMER'S RESIDENTIAL CARE HOME
Entity type:Organization
Organization Name:SUMMER'S RESIDENTIAL CARE HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSEE
Authorized Official - Prefix:
Authorized Official - First Name:TERESITA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOMENDEHE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-567-0759
Mailing Address - Street 1:130 MANITOU ST
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95838-2522
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:130 MANITOU ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95838-2522
Practice Address - Country:US
Practice Address - Phone:916-567-0759
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-18
Last Update Date:2016-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA347001484320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities