Organization
EAGLE LAKE VILLAGE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK J CIMINO (CEO)
(916) 704-6275
Entity
Organization
Contact information
Practice address
2001 PAUL BUNYAN RD., SUSANVILLE, CA 96130
(530) 457-4380
Mailing address
2001 PAUL BUNYAN RD., SUSANVILLE, CA 96130
(530) 457-4380
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
Other
Enumeration date
11/17/2022
Last updated
11/17/2022
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