Organization
SIERRA CARE AT THE LAKE,LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GARY ANDREW PONTICIELLO (PRESIDENT)
(559) 539-1100
Entity
Organization
Contact information
Practice address
33221 GLOBE DR, A, SPRINGVILLE, CA 93265-9715
(559) 539-1100
Mailing address
33221 GLOBE DR, SPRINGVILLE, CA 93265-9715
(559) 539-1100
(559) 539-1200
Taxonomy
Speciality
Code
Description
License number
State
311Z00000X
Custodial Care Facility
550003154
CA
313M00000X
Nursing Facility/Intermediate Care Facility
550003154
CA
314000000X
Skilled Nursing Facility
Primary
—
—
315D00000X
Inpatient Hospice
550003154
CA
Other
Enumeration date
08/15/2014
Last updated
07/29/2016
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