1125 Sir Francis Drake Boulevard Operating Company, LLC
Organization Active NPI Long Term Care Hospital · Kentfield, CA
NPI 1760424261 · NPPES record last updated Oct 3, 2023
Key facts
- NPI
- 1760424261
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Long Term Care Hospital 282E00000X
- License
- 110000358 (CA)
- Legal business name
- 1125 SIR FRANCIS DRAKE BOULEVARD OPERATING COMPANY, LLC
- Practice address
- 1125 Sir Francis Drake Blvd
Kentfield, CA 94904-1418 - Phone
- (415) 456-9680
- Fax
- (415) 485-3696
- NPI assigned
- Jun 11, 2006
- Organization subpart
- No
Authorized official
- Name
- Tammy Jean Thompson
- Title
- Cfo/VP
- Phone
- (209) 287-6308
Other NPIs on the same Medicare enrollment 1
Practitioners 73
-
Adil A Abbasi, M.D.
-
Abulaiti Adili, M.D.
-
Nazish Nawaz Ali, M.D.
-
Edris Aman, M.D.
-
Kwame Bodor-Tsia Atsina, M.D.
-
Khin Nyein Chan Aung, M.D
-
Jasdeep S Bal, M.D
-
Vera Batchu, MD
-
Sicily A Bradley, M.D.
-
Bhuvaneswari Burugapalli, M.D.
-
Simon CHI Yan Chan, M.D.
-
Jatinder S Chana, M.D.
-
Gaurav Datta, MD
-
Amandeep Singh Dhillon, M.D.
-
Jamshid Faraji, M.D.
-
Manrajan Gill, MD
-
Eleonor Loyola Griffith, D.O.
-
Gregory Wade Heinicke, D.O.
-
Jennifer R. Israel, D.O.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20060801000376 | CA | Part B Supplier - Clinic/Group Practice | 1254344617 |
Receives reassigned benefits from 68 practitioners 1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Carmichael, CA; Sacramento, CA |
National Provider Directory
Locations
100 Drakes Landing Rd
Ste 140
Greenbrae, CA 94904
Phone (415) 461-4282
3150 18th St
Ste 265
San Francisco, CA 94110
Phone (415) 823-2246
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Long Term Care Hospital | 282E00000X | 110000358 | CA | Yes |
Addresses
Primary practice location
1125 Sir Francis Drake Blvd
Kentfield, CA 94904-1418
Mailing address
700 17TH St Ste 205
Modesto, CA 95354-1249
Phone (209) 287-6308
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 05-2043 | Other | CA | FREMONT HEALTH |
| 05-2043 | Other | CA | CORVEL |
| 05-2043 | Other | CA | HEALTH NET COMP 24 |
| 05-2043 | Other | CA | CCN INDUSTRIAL MEDICINE |
| HSP40554I | Medicaid | CA | |
| 05-2043 | Other | CA | CCN |
| 05-2043 | Other | CA | FIRST HEALTH |
| 05-2043 | Other | CA | BEECH STREET |
| 05-2043 | Other | CA | MARIN IPA |
| 05-2043 | Other | CA | AETNA |
| 05-2043 | Other | CA | BLUE SHIELD |
| 05-2043 | Other | CA | BLUE CROSS |
| 05-2043 | Other | CA | HEALTH NET |
| 05-2043 | Other | CA | INTERPLAN |
| HSC00554I | Medicaid | CA | |
| 05-2043 | Other | CA | GENERAL REINSURANCE |
| 05-2043 | Other | CA | FOUNDATION HEALTH |
| ZZR005541 | Medicaid | CA | |
| 05-2043 | Other | CA | CAMP AMERICA |
Other names
- Kentfield Rehabilitation & Specialty Hospital
Other providers in Kentfield, CA
- Alex Barchuk M.D., Incorporated
- Sarah Alexander
- Ana Josefina Amaya
- Johanna Tyler Anderson
- Allen L Appell
All providers in Kentfield, CA · Long Term Care Hospital in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 3, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.