Provider Demographics
NPI:1982318481
Name:SUNGARDEN VILLA INC.
Entity Type:Organization
Organization Name:SUNGARDEN VILLA INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSEE
Authorized Official - Prefix:
Authorized Official - First Name:ANAMARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DOCMANOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-757-7057
Mailing Address - Street 1:8440 EDGECLIFF CT
Mailing Address - Street 2:
Mailing Address - City:CITRUS HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:95610-0842
Mailing Address - Country:US
Mailing Address - Phone:916-757-7057
Mailing Address - Fax:
Practice Address - Street 1:8440 EDGECLIFF CT
Practice Address - Street 2:
Practice Address - City:CITRUS HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:95610-0842
Practice Address - Country:US
Practice Address - Phone:916-757-7057
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-09
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility