Provider Demographics
NPI:1811796824
Name:LOVING LEGACY SENIOR CARE
Entity type:Organization
Organization Name:LOVING LEGACY SENIOR CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:VENIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:BANUVE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:279-229-7719
Mailing Address - Street 1:7000 FRANKLIN BLVD STE 140
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95823-1865
Mailing Address - Country:US
Mailing Address - Phone:916-494-9033
Mailing Address - Fax:
Practice Address - Street 1:8216 COTTONBALL WAY
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95828-4414
Practice Address - Country:US
Practice Address - Phone:279-229-7719
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-11
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility