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EAGLE LAKE VILLAGE
NPI 1114636230
Assisted Living Facility in Susanville, CA

Active since November 17, 2022
2001 PAUL BUNYAN RD., SUSANVILLE, CA 96130(530) 457-4380 Get Directions Write a Review

NPPES record last updated: November 17, 2022. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Eagle Lake Village NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

EAGLE LAKE VILLAGE (NPI 1114636230) is a healthcare organization registered as an assisted living facility in Susanville, California and active in the NPI registry since November 2022. The organization lists Mark J Cimino, Ceo, as its authorized official.

NPPES Registry Identity

NPI1114636230
Entity TypeOrganization
Primary Taxonomy310400000X
Legal Business NameEAGLE LAKE VILLAGE
Location Address2001 PAUL BUNYAN RD.Susanville, CA 96130
Mailing Address2001 Paul Bunyan Rd.Susanville, CA 96130 · (530) 457-4380
Phone(530) 457-4380
Organization SubpartNo
Authorized OfficialMark J CiminoCeo · (916) 704-6275
Enumeration DateNovember 17, 2022
NPPES CertifiedNovember 17, 2022
✔ NPI 1114636230 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyAssisted Living FacilityNursing & Custodial Care Facilities
Taxonomy Code310400000X
Definition
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.
2001 PAUL BUNYAN RD., Susanville, CA 96130
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Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Eagle Lake Village's NPI number?

The NPI number for Eagle Lake Village is 1114636230. It was assigned to this organization in the NPPES registry on November 17, 2022.

Where is Eagle Lake Village located?

Eagle Lake Village is located at 2001 Paul Bunyan Rd., Susanville, CA 96130. The listed phone number is (530) 457-4380.

What is Eagle Lake Village's specialty?

The primary specialty registered for this NPI is Assisted Living Facility with taxonomy code 310400000X.

When was this NPI record last updated?

The NPPES record for Eagle Lake Village was last updated on November 17, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.