Citrus Crest Care Home1

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

CITRUS CREST CARE HOME1

Practice address

6906 Henning Dr
Citrus Heights, CA 95621-2840

Phone

(916) 728-1338

NPI assigned

Feb 13, 2023

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mariam Gbaty Soumahoro

Title

Ceo

Phone

(510) 409-7096

Specialties & licenses 1

Addresses

Other names 1

• Citrus Crest Care Home 1 LLC Former legal business name

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1676246400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1676246400000",
    "number": "1083311757",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6906 HENNING DR",
            "city": "CITRUS HEIGHTS",
            "state": "CA",
            "postal_code": "956212840",
            "telephone_number": "916-728-1338"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6906 HENNING DR",
            "city": "CITRUS HEIGHTS",
            "state": "CA",
            "postal_code": "956212840",
            "telephone_number": "916-728-1338"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CITRUS CREST CARE HOME1",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-02-13",
        "last_updated": "2023-02-13",
        "certification_date": "2023-02-13",
        "status": "A",
        "authorized_official_last_name": "SOUMAHORO",
        "authorized_official_first_name": "MARIAM",
        "authorized_official_middle_name": "GBATY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "510-409-7096"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Citrus Crest Care Home 1 LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• John Paul Diamsay Cielo-Dunbar
• Ciminocare
• Delia Ciobanu
• Wendy Ciotti
• Citrus Crest Care Home 2 LLC
• Citrus Heights Community Healthcare, LLC
• Citrus Heights Dental
• Citrus Heights Terrace
• Citrus Plaza Medical Supply
• Payton Morgan Clark Smith

• Assisted Living Facility in Citrus Heights, CA
• Providers in Citrus Heights, CA by specialty
• Assisted Living Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.