Petaluma Skilled Nursing & Wellness Centre, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

PETALUMA SKILLED NURSING & WELLNESS CENTRE, LLC

Doing business as

Country Villa Petaluma Healthcare Center

Practice address

523 Hayes LN
Petaluma, CA 94952-4011

Phone

(707) 763-2457

Fax

(707) 765-2176

NPI assigned

Oct 15, 2007

Organization subpart

No

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

Authorized official

Name

Mr. Stephen E. Reissman

Title

Ceo

Phone

(310) 574-3733

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Country Villa Petaluma Healthcare Center Doing business as

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

{
    "created_epoch": "1192406400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1192406400000",
    "number": "1669661716",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5120 W GOLDLEAF CIR",
            "address_2": "SUITE 400",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900561292",
            "telephone_number": "310-574-3733",
            "fax_number": "310-574-1322"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "523 HAYES LN",
            "city": "PETALUMA",
            "state": "CA",
            "postal_code": "949524011",
            "telephone_number": "707-763-2457",
            "fax_number": "707-765-2176"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PETALUMA SKILLED NURSING & WELLNESS CENTRE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-15",
        "last_updated": "2007-10-15",
        "status": "A",
        "authorized_official_last_name": "REISSMAN",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_middle_name": "E.",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "310-574-3733",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "LTC55703F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Country Villa Petaluma Healthcare Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Petaluma Health Center, Inc. (Petaluma Health Center Pharmacy)
• Petaluma Healthcare & Wellness Centre, LP
• Petaluma People Services Center
• Petaluma People Services Center
• Petaluma Physical Therapy Associates Inc (Petaluma Valley Physical Therapy Center)
• Petaluma SNF Healthcare, LLC (Ridgeway Post Acute)
• Petaluma Specialty Center, LLC.
• Petaluma Surgicenter
• Petaluma Taxi Services LLC
• Petaluma Tracen Uscg Phcy

• 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 Oct 15, 2007; 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.