Petaluma C.C. Inc.

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

010000056 Issued in CA

Legal business name

PETALUMA C.C. INC.

Practice address

1115 B St
Petaluma, CA 94952-4028

Phone

(707) 765-3030

NPI assigned

Dec 7, 2005

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Marc Johnson

Title

Cfo

Phone

(949) 373-8373

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• PETALUMA CARE AND REHABILITATION Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1133913600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1712275200000",
    "number": "1659356160",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1115 B ST",
            "city": "PETALUMA",
            "state": "CA",
            "postal_code": "949524028",
            "telephone_number": "707-765-3030"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1115 B ST",
            "city": "PETALUMA",
            "state": "CA",
            "postal_code": "949524028",
            "telephone_number": "707-765-3030"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PETALUMA C.C. INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-07",
        "last_updated": "2024-04-05",
        "certification_date": "2024-04-05",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "MARC",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "949-373-8373"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "CA",
            "license": "010000056",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZZR06072H",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PETALUMA CARE AND REHABILITATION",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kimberly Juanita Perez
• Orren Z Perlman, MD
• Praveena Permalla, DDS
• Personal Hearing Solutions, Inc.
• Petaluma Acupuncture Center
• Petaluma City Schools
• Petaluma Emergency Physicians Medical Corporation
• Petaluma Eye Care Optometric Associates, Inc.
• Petaluma Eye Care Optometric Associates, Inc. a Professional Corp.
• Petaluma Family Dental Care

• Skilled Nursing Facility in Petaluma, CA
• Providers in Petaluma, CA by specialty
• Skilled Nursing Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.