Provider Demographics
NPI:1548663743
Name:YOUNG AT HEART RCFE NO. 4
Entity type:Organization
Organization Name:YOUNG AT HEART RCFE NO. 4
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LILLIAN
Authorized Official - Middle Name:T
Authorized Official - Last Name:SISAYAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:916-686-8822
Mailing Address - Street 1:9012 COLOMBARD WAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95829-1209
Mailing Address - Country:US
Mailing Address - Phone:916-686-8822
Mailing Address - Fax:
Practice Address - Street 1:9012 COLOMBARD WAY
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95829-1209
Practice Address - Country:US
Practice Address - Phone:916-682-6080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-01
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA347003792311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home