Provider Demographics
NPI:1174896807
Name:MCGREGOR HOME CARMICHAEL
Entity type:Organization
Organization Name:MCGREGOR HOME CARMICHAEL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/LICENSEE
Authorized Official - Prefix:MRS
Authorized Official - First Name:HEIDI REMEDIOS
Authorized Official - Middle Name:SANTOS
Authorized Official - Last Name:ARANA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-873-4197
Mailing Address - Street 1:5712 LOCUST AVE
Mailing Address - Street 2:
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-1321
Mailing Address - Country:US
Mailing Address - Phone:916-971-9958
Mailing Address - Fax:916-467-7282
Practice Address - Street 1:5712 LOCUST AVE
Practice Address - Street 2:
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-1321
Practice Address - Country:US
Practice Address - Phone:916-971-9958
Practice Address - Fax:916-467-7282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-10
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA347004109310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility