Provider Demographics
NPI:1861993099
Name:A SUMMERDALE HOMES @ RIBEIRO LLC
Entity type:Organization
Organization Name:A SUMMERDALE HOMES @ RIBEIRO LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:ROBLES
Authorized Official - Last Name:GASATAYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-855-4862
Mailing Address - Street 1:1868 RIBEIRO CIR
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89503-4035
Mailing Address - Country:US
Mailing Address - Phone:775-746-1949
Mailing Address - Fax:775-746-9244
Practice Address - Street 1:1868 RIBEIRO CIR
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89503-4035
Practice Address - Country:US
Practice Address - Phone:775-746-1949
Practice Address - Fax:775-746-9244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-22
Last Update Date:2018-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2194-AGC-27310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility