1629956222 NPI number — GRANITE SPRING CARE HOME I INC

Table of content: CARLINE LECLERC FLEIG RNP (NPI 1851370498)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629956222 NPI number — GRANITE SPRING CARE HOME I INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GRANITE SPRING CARE HOME I INC
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:
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:
1629956222
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
208 AERIE CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROSEVILLE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95661-4063
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-952-4192
Provider Business Mailing Address Fax Number:
916-899-6402

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
208 AERIE CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROSEVILLE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95661-4063
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-952-4192
Provider Business Practice Location Address Fax Number:
916-899-6402
Provider Enumeration Date:
08/22/2025

Additional Information

Authorized Official

Authorized Official Last Name:
FOKSHA
Authorized Official First Name:
NATALYA
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
916-952-4192

Provider Taxonomy Codes

  • Taxonomy code: 310400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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