Provider Demographics
NPI:1225855232
Name:SUMERLIN GUEST HOME LLC
Entity type:Organization
Organization Name:SUMERLIN GUEST HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSEE
Authorized Official - Prefix:
Authorized Official - First Name:LAILA
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNGCA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-304-4357
Mailing Address - Street 1:8671 SUMERLIN CT
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95624-1545
Mailing Address - Country:US
Mailing Address - Phone:916-340-4357
Mailing Address - Fax:
Practice Address - Street 1:8671 SUMERLIN CT
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95624-1545
Practice Address - Country:US
Practice Address - Phone:916-340-4357
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-21
Last Update Date:2024-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility