Organization
COUNTRY CLUB MANOR
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. STUART M DRAKE (EXEC. ADMINISTRATOR)
(916) 481-9240
Entity
Organization
Contact information
Practice address
2100 BUTANO DR, SACRAMENTO, CA 95825-0448
(916) 481-9240
(916) 483-7134
Mailing address
2100 BUTANO DR, SACRAMENTO, CA 95825-0448
(916) 481-9240
(916) 483-7134
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
RCF00022F
—
CA
Enumeration date
02/07/2007
Last updated
08/22/2020
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