Leilani Dizon Aragon

Individual provider Active NPI Assisted Living Facility · Fair Oaks, CA

NPI 1457907255 · NPPES record last updated Aug 16, 2019

Key facts

NPI
1457907255
Entity type
Individual (NPI type 1)
Primary specialty
Assisted Living Facility 310400000X
License
342700350 (CA)
Practice address
5929 Spring Glen Dr
Fair Oaks, CA 95628-2729
Phone
(916) 844-7582
NPI assigned
Aug 16, 2019
Sex
Female
Sole proprietor
Yes

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
342700350CAMDAssisted Living Facility

Practice roles

OrganizationSpecialtyStatusNew patients
Spring Glen Elderly Care Villa Assisted Living Facility Current
since Sep 8, 2019
Accepting new patients

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility 310400000X 342700350 CA Yes

Addresses

Primary practice location

5929 Spring Glen Dr
Fair Oaks, CA 95628-2729

Mailing address

331 Portico CT
Tracy, CA 95377-1107

Other providers in Fair Oaks, CA

All providers in Fair Oaks, CA · Assisted Living Facility in California

Sources for this page

Verify at the official NPI Registry.