1114922614 NPI number — ESKATON PROPERTIES, INCORPORATED

Table of content: (NPI 1114922614)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114922614 NPI number — ESKATON PROPERTIES, INCORPORATED

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ESKATON PROPERTIES, INCORPORATED
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114922614
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/30/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5105 MANZANITA AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CARMICHAEL
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95608-0523
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-334-0810
Provider Business Mailing Address Fax Number:
916-338-1248

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
455 FLORIN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SACRAMENTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95831-2024
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-393-2550
Provider Business Practice Location Address Fax Number:
916-393-1706
Provider Enumeration Date:
06/20/2005

Additional Information

Authorized Official

Authorized Official Last Name:
JENKINS
Authorized Official First Name:
MARK
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
916-334-0810

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  030000158 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: LTC55098F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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