Provider Demographics
NPI:1174395800
Name:SIGNATURE LIVING ON CAMELIE AVENUE LLC
Entity type:Organization
Organization Name:SIGNATURE LIVING ON CAMELIE AVENUE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:AFABLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-952-4348
Mailing Address - Street 1:5121 ROCKY MOUNTAIN WAY
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95747-9347
Mailing Address - Country:US
Mailing Address - Phone:916-952-4348
Mailing Address - Fax:916-721-2762
Practice Address - Street 1:904 CAMELIA AVE
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95678-3302
Practice Address - Country:US
Practice Address - Phone:916-899-5880
Practice Address - Fax:916-721-2762
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-25
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility