OrganizationActive
Eagle Lake Village
NPI 1114636230 · Assisted Living Facility · Susanville, CA
Eagle Lake Village is a Assisted Living Facility organization in Susanville, CA (NPI 1114636230).
Provider details
- NPI number
- 1114636230
- Entity type
- Organization
- Primary specialty
- Assisted Living FacilityNursing & Custodial Care Facilities
- Organization subpart
- No
- Authorized official
- Mark Cimino, Ceo(916) 704-6275
Specialties & taxonomies
Nursing & Custodial Care Facilities
Profile Score
Established profile(59/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
3 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
2001 Paul Bunyan Rd.
Susanville, CA 96130
Phone: (530) 457-4380
Street-level locationGet directions
Mailing address
2001 Paul Bunyan Rd.
Susanville, CA 96130
Registry dates
- Enumerated
- 2022-11-17
- Last updated
- 2022-11-17
- Certified
- 2022-11-17
Frequently asked questions
- What is Eagle Lake Village's NPI number?
- Eagle Lake Village's National Provider Identifier (NPI) is 1114636230, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What type of organization is Eagle Lake Village?
- Eagle Lake Village is classified in the NPPES registry as Assisted Living Facility (Nursing & Custodial Care Facilities).
- Where is Eagle Lake Village located?
- Eagle Lake Village's practice location on file with NPPES is 2001 Paul Bunyan Rd., Susanville, CA 96130.
- What is Eagle Lake Village's phone number?
- The practice phone number listed in the NPPES registry for Eagle Lake Village is (530) 457-4380.
- Who is the authorized official for Eagle Lake Village?
- The authorized official listed on Eagle Lake Village's NPPES record is Mark Cimino, Ceo. The authorized official registers and maintains the organization's NPI and is not necessarily its owner.
- Is Eagle Lake Village's NPI active?
- Yes — Eagle Lake Village's NPI (1114636230) is active in the NPPES registry as of the last update on 2022-11-17.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.