Provider Demographics
NPI:1902310774
Name:ACP CARMICHAEL
Entity Type:Organization
Organization Name:ACP CARMICHAEL
Other - Org Name:SAGEBROOK SENIOR LIVING AT CARMICHAEL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSENSTOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-271-9635
Mailing Address - Street 1:104 E MAIN ST STE 404
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-4787
Mailing Address - Country:US
Mailing Address - Phone:760-271-9635
Mailing Address - Fax:
Practice Address - Street 1:7125 FAIR OAKS BLVD
Practice Address - Street 2:
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-6450
Practice Address - Country:US
Practice Address - Phone:916-481-7105
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-30
Last Update Date:2017-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility