Elk Vista Residential Home LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

ELK VISTA RESIDENTIAL HOME LLC

Practice address

8933 Shady Vista CT
Elk Grove, CA 95624-2730

Phone

(916) 686-2159

NPI assigned

Dec 12, 2024

Last updated

Dec 12, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Fabiola Nunez

Title

Licensee

Phone

(916) 686-2159

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1733961600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1733961600000",
    "number": "1467269464",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8933 SHADY VISTA CT",
            "city": "ELK GROVE",
            "state": "CA",
            "postal_code": "956242730",
            "telephone_number": "916-686-2159"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8933 SHADY VISTA CT",
            "city": "ELK GROVE",
            "state": "CA",
            "postal_code": "956242730",
            "telephone_number": "916-686-2159"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELK VISTA RESIDENTIAL HOME LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-12-12",
        "last_updated": "2024-12-12",
        "certification_date": "2024-12-12",
        "status": "A",
        "authorized_official_last_name": "NUNEZ",
        "authorized_official_first_name": "FABIOLA",
        "authorized_official_title_or_position": "LICENSEE",
        "authorized_official_telephone_number": "916-686-2159"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Assisted Living Facility in Elk Grove, CA
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• Assisted Living Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2024; 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.