Healthcare Provider Details

I. General information

NPI: 1558231621
Provider Name (Legal Business Name): REBEKAH'S RETREAT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2025
Last Update Date: 11/05/2025
Certification Date: 11/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1857 HOWE ST
FAIRFIELD CA
94534-3028
US

IV. Provider business mailing address

1857 HOWE ST
FAIRFIELD CA
94534-3028
US

V. Phone/Fax

Practice location:
  • Phone: 707-803-1297
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: REBEKAH FISHER
Title or Position: LICENSEE
Credential:
Phone: 707-803-1297