Provider Demographics
NPI:1679635601
Name:SCOTTSDALE GUEST HOME
Entity type:Organization
Organization Name:SCOTTSDALE GUEST HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CORAZON
Authorized Official - Middle Name:DE ALA
Authorized Official - Last Name:EPISCOPE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-682-2305
Mailing Address - Street 1:8047 ROCKHURST WAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95828
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:916-688-7745
Practice Address - Street 1:8047 ROCKHURST WAY
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95828-4226
Practice Address - Country:US
Practice Address - Phone:916-682-2305
Practice Address - Fax:916-688-7745
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-15
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA347000357311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home