Organization · NPI-2

Diamond Village Care Home, LLC

Custodial Care Facility, Adult Care Home · Sacramento, CA

NPI number1740864172
StatusActive
Last updated in NPPESMay 11, 2021

Details

NPI
1740864172
Entity type
Organization (NPI-2)
Legal business name
Diamond Village Care Home, LLC
Organization subpart
No
Enumeration date
May 11, 2021
Certification date
May 11, 2021
Last updated
May 11, 2021

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
311ZA0620X Custodial Care Facility, Adult Care Home––Yes
320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities––

Practice location

8709 Crystal River Way
Sacramento, CA 95828-5140

Phone 607-592-1611

Mailing address

8709 Crystal River Way
Sacramento, CA 95828-5140

Authorized official

Roxanne Omoaholo
Owner/Manager
6075921611

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