Provider Demographics
NPI:1154107746
Name:ALC ASSISTED LIVING INC
Entity type:Organization
Organization Name:ALC ASSISTED LIVING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JEANINA
Authorized Official - Middle Name:B
Authorized Official - Last Name:LUP
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:916-500-2163
Mailing Address - Street 1:6705 JUDISTINE DR
Mailing Address - Street 2:
Mailing Address - City:FAIR OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:95628-3015
Mailing Address - Country:US
Mailing Address - Phone:916-500-2163
Mailing Address - Fax:916-844-7178
Practice Address - Street 1:6705 JUDISTINE DR
Practice Address - Street 2:
Practice Address - City:FAIR OAKS
Practice Address - State:CA
Practice Address - Zip Code:95628-3015
Practice Address - Country:US
Practice Address - Phone:916-500-2163
Practice Address - Fax:916-844-7178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-07
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility