Provider Demographics
NPI:1316632771
Name:YELLOWTAIL HOME CARE LLC
Entity type:Organization
Organization Name:YELLOWTAIL HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:YING
Authorized Official - Middle Name:
Authorized Official - Last Name:LIU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-868-4236
Mailing Address - Street 1:8161 CHIMANGO CT
Mailing Address - Street 2:
Mailing Address - City:ANTELOPE
Mailing Address - State:CA
Mailing Address - Zip Code:95843-5332
Mailing Address - Country:US
Mailing Address - Phone:916-868-4236
Mailing Address - Fax:
Practice Address - Street 1:8513 YELLOWTAIL WAY
Practice Address - Street 2:
Practice Address - City:ANTELOPE
Practice Address - State:CA
Practice Address - Zip Code:95843-4951
Practice Address - Country:US
Practice Address - Phone:916-868-4236
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-10
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA342700766OtherDEPARTMENT OF SOCIAL SERVICES, CCLD