COUNTRY CLUB MANOR NPI 1033259213

NPI Information

NPI: 1033259213
Provider Name: COUNTRY CLUB MANOR
Classification: Assisted Living Facility - 310400000X
Entity Type: Organization
Address:
2100 BUTANO DR
SACRAMENTO, CA
ZIP 95825
Phone: (916) 481-9240
Get Directions

COUNTRY CLUB MANOR is an assisted living facility in Sacramento, CA. The provider is a facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being. COUNTRY CLUB MANOR NPI is 1033259213. The provider is registered as an organization entity type.

The provider's business location address is:

2100 BUTANO DR
SACRAMENTO, CA
ZIP 95825-448
Phone: (916) 481-9240
Fax: (916) 483-7134

The provider's authorized official is Stuart M Drake .
The authorized official title is Exec. Administrator and has the following contact phone number (916) 481-9240.

The enumeration date for this NPI number is 2/7/2007 and was last updated on 8/22/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	310400000X	Assisted Living Facility			CALIFORNIA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	RCF00022F	MEDICAID	CALIFORNIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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