Provider Demographics
NPI:1194121129
Name:CIMINOCARE CAREFREE ASSISTED LIVING D/B/A FRUITRIDGE VILLA
Entity type:Organization
Organization Name:CIMINOCARE CAREFREE ASSISTED LIVING D/B/A FRUITRIDGE VILLA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ADINA
Authorized Official - Middle Name:
Authorized Official - Last Name:NITU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-704-0328
Mailing Address - Street 1:5490 ENRICO BLVD
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95820-6438
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5490 ENRICO BLVD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95820-6438
Practice Address - Country:US
Practice Address - Phone:916-704-0328
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-19
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA347005281310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility