Provider Demographics
NPI:1538429253
Name:STONE BAY HOME ICF, LLC
Entity type:Organization
Organization Name:STONE BAY HOME ICF, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSEE
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANTONIETTE
Authorized Official - Middle Name:A
Authorized Official - Last Name:ASTORGA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:916-662-5684
Mailing Address - Street 1:9076 STONE BAY COURT
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95829-9517
Mailing Address - Country:US
Mailing Address - Phone:916-662-5684
Mailing Address - Fax:916-688-5147
Practice Address - Street 1:9076 STONE BAY CT
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95829-9517
Practice Address - Country:US
Practice Address - Phone:916-662-5684
Practice Address - Fax:916-688-5147
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-29
Last Update Date:2012-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility