Lake Shasta, LLC
NPI #1952118135 in Antioch, California
Provider Information
- NPI Number
- 1952118135
- Entity Type
- Organization
- Organization Name
- Lake Shasta, LLC
- Primary Specialty
- Assisted Living Facility
- Enumeration Date
- Dec 12, 2024
- Last Updated
- Dec 12, 2024
Practice Location
- Address
- 825 E 18TH ST
- City
- Antioch
- State
- California
- ZIP Code
- 94509-2835
- Phone
- (925) 706-7944
Authorized Official
- Name
- RYAN WILLIAMS
- Title
- MANAGING MEMBER
- Phone
- (916) 299-7030
Specialties & Taxonomy Codes
| Specialty |
|---|
| Assisted Living Facility |
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