Organization
DIAMOND VILLAGE CARE HOME, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROXANNE OMOAHOLO (OWNER/MANAGER)
(607) 592-1611
Entity
Organization
Contact information
Practice address
8709 CRYSTAL RIVER WAY, SACRAMENTO, CA 95828-5140
(607) 592-1611
Mailing address
8709 CRYSTAL RIVER WAY, SACRAMENTO, CA 95828-5140
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
—
—
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
—
—
Other
Enumeration date
05/11/2021
Last updated
05/11/2021
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