Healthcare Provider Details

I. General information

NPI: 1548963127
Provider Name (Legal Business Name): BALEEN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2023
Last Update Date: 03/23/2023
Certification Date: 03/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5318 MANZANITA AVE
CARMICHAEL CA
95608-0512
US

IV. Provider business mailing address

2266 LAVA RIDGE CT
ROSEVILLE CA
95661-2856
US

V. Phone/Fax

Practice location:
  • Phone: 916-331-8513
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: DAN BUSHNELL
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 949-508-8370