EAGLE LAKE VILLAGE – NPI #1114636230
Assisted Living Facility

A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being.

Health Care Provider Taxonomy Code for Assisted Living Facility

EAGLE LAKE VILLAGE is an assisted living facility located in SUSANVILLE, CA. NPPES has assigned the NPI number 1114636230 to EAGLE LAKE VILLAGE on November 17, 2022. It is a Type-2 NPI, indicating this NPI number is associated with an organization. The primary taxonomy selected by this provider is 310400000X from the Health Care Provider Taxonomy code set, which is classified as Assisted Living Facility.

Use the NPI data found here to bill health insurance companies, identify providers enrolled in Medicare and Medicaid services or other HIPAA compliant transactions. See the complete NPI profile for EAGLE LAKE VILLAGE below.

NPI Profile for
EAGLE LAKE VILLAGE

NPI Number
1114636230
Enumeration Date

(more than 3 years ago)
Entity Type
Type-2  Organization
Organization health care providers may have a single employee or thousands of employees. An example is an incorporated individual who is an organization's only employee.
Legal Name
EAGLE LAKE VILLAGE
Primary location
2001 PAUL BUNYAN RD.
SUSANVILLE, CA 96130
Phone: (530) 457-4380 Fax:
Mailing address
Same as primary location
Organization Subpart
No
Authorized Official
MARK CIMINO
CEO
Phone: (916) 704-6275
Updated
Certification Date
Nov 17, 2022

Note: NPPES allows providers to attest to the accuracy of their NPI data. When a provider request any change to the NPI record, they will be able to attest to their changed NPI data, resulting in an updated certification date.

Taxonomy Code(s)

A taxonomy code is a code that describes the health care service provider's type, classification, and the area of specialization. The primary specialty for this provider is indicated as (Primary) below.

Taxonomy Classification / Specialization State License
310400000X
- Assisted Living Facility (Primary)

The taxonomy codes are selected by the provider at the time of NPI registration. Selection of a taxonomy code does not replace any credentialing or validation process that the provider requesting the code should complete.