Healthcare Provider Details

I. General information

NPI: 1942115308
Provider Name (Legal Business Name): NANA'S HOUSE SOLANO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5265 TROPHY DR # A
FAIRFIELD CA
94534-4054
US

IV. Provider business mailing address

4160 SUISUN VALLEY RD # E610
FAIRFIELD CA
94534-4016
US

V. Phone/Fax

Practice location:
  • Phone: 510-295-9100
  • Fax:
Mailing address:
  • Phone: 510-295-9100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code276400000X
TaxonomySubstance Use Disorder Rehabilitation Hospital Unit
License Number
License Number State

VIII. Authorized Official

Name: LISA TOLBERT
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 510-295-9100