Organization
SEYKAT CORP
Active
Other names
shasta home
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DARIUSH RAZAVI (ADMINISTRATOR)
(619) 465-8010
Entity
Organization
Contact information
Practice address
5502 SHASTA LN, LA MESA, CA 91942-4430
(619) 644-1144
(619) 465-8348
Mailing address
7979 LA MESA BLVD, LA MESA, CA 91941-5065
(619) 465-8010
(619) 465-8348
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
08000061
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
08000061
STATE LICENSE
CA
Enumeration date
04/11/2007
Last updated
08/22/2020
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