Individual provider · NPI-1

Kelly Acacio

Custodial Care Facility, Adult Care Home · Sacramento, CA

NPI number1063112944
StatusActive
Last updated in NPPESMar 8, 2023

Details

NPI
1063112944
Entity type
Individual (NPI-1)
Name
Kelly Acacio
Sex
Male
Sole proprietor
Yes
Enumeration date
Mar 8, 2023
Certification date
Mar 8, 2023
Last updated
Mar 8, 2023

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
311ZA0620X Custodial Care Facility, Adult Care Home347001602CAYes

Practice location

8333 Holly Jill Way
Sacramento, CA 95823-5615

Phone 916-895-4771

Mailing address

8333 Holly Jill Way
Sacramento, CA 95823-5615

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