Provider Demographics
NPI:1427692128
Name:CG ESTEPA CARE HOME 2, INC.
Entity type:Organization
Organization Name:CG ESTEPA CARE HOME 2, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:GEMMA
Authorized Official - Middle Name:CACCAM
Authorized Official - Last Name:ESTEPA
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:916-670-0180
Mailing Address - Street 1:11894 ELK VIEW WAY
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95742-8132
Mailing Address - Country:US
Mailing Address - Phone:916-670-0180
Mailing Address - Fax:
Practice Address - Street 1:12800 THORNBERG WAY
Practice Address - Street 2:
Practice Address - City:RANCHO CORDOVA
Practice Address - State:CA
Practice Address - Zip Code:95742-7812
Practice Address - Country:US
Practice Address - Phone:916-670-0180
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-05
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility