MEDICARE: MUIR WOOD, LLC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3245S0500X	Children's Substance Abuse Rehabilitation Facility
2	323P00000X	Psychiatric Residential Treatment Facility

General Provider Information

NPI Number	:	1699459966
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MUIR WOOD, LLC.

Provider Business Mailing Address
First Line	:	201 1ST ST STE 111
Second Line	:
City	:	PETALUMA
State	:	CA
Zip	:	94952-4291
Country	:	US
Telephone Number	:	415-497-7722
Fax Number	:	707-781-4276

Provider Business Practice Location Address
First Line	:	6851 COLD SPRINGS RD
Second Line	:
City	:	PENNGROVE
State	:	CA
Zip	:	94951-9722
Country	:	US
Telephone Number	:	855-684-7966
Fax Number	:	707-559-5401

Authorized Official
Title or Position	:	COO
Name	:	BRYAN BOWEN
Credential	:
Telephone Number	:	415-497-7722

Provider Enumeration Date	:	06/14/2023
Last Update Date	:	09/25/2025

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Directions to “MUIR WOOD, LLC. ” Practice Location

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