Provider Demographics
NPI:1679391809
Name:RC PREMIER VILLA II
Entity type:Organization
Organization Name:RC PREMIER VILLA II
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ZADEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:CABRERA
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:573-717-0687
Mailing Address - Street 1:1514 SYRACUSE DR
Mailing Address - Street 2:
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95765-6256
Mailing Address - Country:US
Mailing Address - Phone:573-717-0687
Mailing Address - Fax:
Practice Address - Street 1:8138 ROBERT CREEK CT
Practice Address - Street 2:
Practice Address - City:CITRUS HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:95610-0801
Practice Address - Country:US
Practice Address - Phone:573-717-0687
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-27
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility