Evergreen At Petaluma, L.L.C. in Petaluma - Skilled Nursing Facility
Evergreen At Petaluma, L.L.C. - NPI 1104874940
Evergreen At Petaluma, L.L.C. is a Skilled Nursing Facility in Petaluma, California. Evergreen At Petaluma, L.L.C. practices all healthcare services and medical treatments related to Skilled Nursing Facility. The NPI Number for Evergreen At Petaluma, L.L.C. is 1104874940. The last update date is 2017-01-30.
Evergreen At Petaluma, L.L.C.'s current location address is 300 Douglas St, Petaluma, California. You can contact this provider via phone number 7077636887 and fax number 7077630314. The mailing address for Evergreen At Petaluma, L.L.C. is 300 Douglas St, Petaluma, California. To know further, please read the information below!
Provider Profile Detail
| Provider Organization | Evergreen At Petaluma, L.L.C. |
|---|---|
| Address | 300 Douglas St, Petaluma, California |
| Phone Number | 7077636887 |
| Fax Number | 7077630314 |
| Sole Proprietor | -- |
| Credentials | -- |
Authorized Official
| Title or Position | CEO AND MA |
|---|---|
| Authorized Official Name | Weil Brent |
| Telephone Number | 3608926628 |
NPI Number Detail
| NPI Number | 1104874940 |
|---|---|
| Provider Enumeration Date | 2006-05-04 |
| Last Updated Date | 2017-01-30 |
Provider Mailing Address Detail
| Address | 300 Douglas St |
|---|---|
| City | Petaluma |
| State | California (CA) |
| Post Code | 949522503 |
| Phone Number | 7077636887 |
| Fax Number | 7077630314 |
Provider's Primary Taxonomy Detail
| Speciality | Skilled Nursing Facility |
|---|---|
| Taxonomy | 314000000X |
| Licence No | 10000018 |
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Definition: (1) A skilled nursing facility is a facility or distinct part of an institution whose primary function is to provide medical, continuous nursing, and other health and social services to patients who are not in an acute phase of illness requiring serv |
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Provider's Other Legacy Identifiers
| Identifier | Identifier Type | Identifier State | Identifier Issuer |
|---|---|---|---|
| ZZRO6120J | CA | -- |
Post Comment/ Review Below
What is the unique identifier code issued to Evergreen At Petaluma, L.L.C. by the Centers for Medicare & Medicaid Services?
The Evergreen At Petaluma, L.L.C. has been assigned the NPI (National Provider Identifier) 1104874940. This 10-digit code serves as a unique identification number for healthcare providers issued by the Centers for Medicare & Medicaid Services (CMS).
Could you please provide the complete physical location address of Evergreen At Petaluma, L.L.C.?
The Evergreen At Petaluma, L.L.C. is physically situated at 300 Douglas St, in the city of Petaluma, state of CA, with the postal code 949522503.
What is the Evergreen At Petaluma, L.L.C.'s area of specialization and corresponding taxonomy classification?
The Evergreen At Petaluma, L.L.C.'s specialty field is Skilled Nursing Facility, and it falls under the taxonomy code 314000000X, which categorizes healthcare providers based on their specialties.
On what date did the Centers for Medicare & Medicaid Services assign the 1104874940 to Evergreen At Petaluma, L.L.C.?
The Centers for Medicare & Medicaid Services assigned the 1104874940 to Evergreen At Petaluma, L.L.C. on 2006-05-04.
As of what date were the Evergreen At Petaluma, L.L.C.'s details last updated?
The information pertaining to the Evergreen At Petaluma, L.L.C., including its address, specialty, and other details, was most recently updated on 2017-01-30.