# MACKELLAH HOME

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1043300320
- **Authorized official:** MR. NELSON SANTOS JACINTO (OWNER)
- **Authorized official phone:** (916) 725-6348

## Contact information

- **Practice address:** 6813 MARINVALE DR, CITRUS HEIGHTS, CA 95621-1937
- **Practice address phone:** (916) 725-6348
- **Mailing address:** 6813 MARINVALE DR, CITRUS HEIGHTS, CA 95621-1937
- **Mailing address phone:** (916) 725-6348

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 311ZA0620X | Adult Care Home Facility | 347000955 | CA | Yes |

## Other

- **Enumeration date:** 10/15/2006
- **Last updated:** 07/08/2008