MEDICARE: MILLS-PENINSULA HEALTH SERVICES

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	261QR0401X	Comprehensive Outpatient Rehabilitation Facility (CORF)	070000551	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1952547788
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MILLS-PENINSULA HEALTH SERVICES

Provider Business Mailing Address
First Line	:	PO BOX 60000
Second Line	:	FILE 73688
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94160-0001
Country	:	US
Telephone Number	:	650-652-3803
Fax Number	:

Provider Business Practice Location Address
First Line	:	1720 EL CAMINO REAL
Second Line	:	SUITE 10
City	:	BURLINGAME
State	:	CA
Zip	:	94010-3225
Country	:	US
Telephone Number	:	650-696-3660
Fax Number	:

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	ROBERT MERWIN
Credential	:
Telephone Number	:	650-696-5270

Provider Enumeration Date	:	12/29/2008
Last Update Date	:	12/29/2008

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