Provider Demographics
NPI:1285735084
Name:ASSISTED LIVING THERAPIES
Entity type:Organization
Organization Name:ASSISTED LIVING THERAPIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OCCUPATIONAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:ANNA
Authorized Official - Last Name:ZIMMERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MSOTR
Authorized Official - Phone:530-677-5294
Mailing Address - Street 1:3657 BLUEBERRY HILL DR
Mailing Address - Street 2:
Mailing Address - City:SHINGLE SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:95682-8885
Mailing Address - Country:US
Mailing Address - Phone:530-677-5294
Mailing Address - Fax:530-677-5294
Practice Address - Street 1:3657 BLUEBERRY HILL DR
Practice Address - Street 2:
Practice Address - City:SHINGLE SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:95682-8885
Practice Address - Country:US
Practice Address - Phone:530-677-5294
Practice Address - Fax:530-677-5294
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT4110310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ22820ZMedicare ID - Type UnspecifiedGROUP NUMBER