Healthcare Provider Details

I. General information

NPI: 1750198933
Provider Name (Legal Business Name): BULLARDS BAR, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2024
Last Update Date: 12/12/2024
Certification Date: 12/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1081 MOHR LN
CONCORD CA
94518-3757
US

IV. Provider business mailing address

599 MENLO DR
ROCKLIN CA
95765-3725
US

V. Phone/Fax

Practice location:
  • Phone: 925-798-3900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: RYAN WILLIAMS
Title or Position: MANAGING MEMBER
Credential:
Phone: 916-299-7030