Lake Shasta, LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

LAKE SHASTA, LLC

Practice address

825 E 18TH St
Antioch, CA 94509-2835

Phone

(925) 706-7944

NPI assigned

Dec 12, 2024

Organization subpart

No

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

Authorized official

Name

Ryan Williams

Title

Managing Member

Phone

(916) 299-7030

Specialties & licenses 1

Addresses

Other names 1

• Delta Shores Assisted Living Doing business as

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": "1952118135",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "599 MENLO DR",
            "city": "ROCKLIN",
            "state": "CA",
            "postal_code": "957653725",
            "telephone_number": "916-299-7030"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "825 E 18TH ST",
            "city": "ANTIOCH",
            "state": "CA",
            "postal_code": "945092835",
            "telephone_number": "925-706-7944"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE SHASTA, 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": "WILLIAMS",
        "authorized_official_first_name": "RYAN",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "916-299-7030"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Delta Shores Assisted Living",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Assisted Living Facility in Antioch, CA
• Providers in Antioch, 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 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.