Provider Demographics
NPI:1528899820
Name:ARYSA LLC
Entity type:Organization
Organization Name:ARYSA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LUZ
Authorized Official - Middle Name:
Authorized Official - Last Name:MARCOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-598-1186
Mailing Address - Street 1:3432 GRANITE CT
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95212-3406
Mailing Address - Country:US
Mailing Address - Phone:209-598-1186
Mailing Address - Fax:
Practice Address - Street 1:2216 ALPINE DR
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95240-6703
Practice Address - Country:US
Practice Address - Phone:209-275-4065
Practice Address - Fax:209-339-1917
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-09
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310500000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Mental Illness