Healthcare Provider Details

I. General information

NPI: 1205443025
Provider Name (Legal Business Name): NORCAL HEALTHCONNECT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2020
Last Update Date: 05/09/2025
Certification Date: 05/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1375 UNIVERSITY AVE
HEALDSBURG CA
95448-3382
US

IV. Provider business mailing address

PO BOX 31001-3085
PASADENA CA
91110-3085
US

V. Phone/Fax

Practice location:
  • Phone: 707-431-6500
  • 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: DONALD W ANDERSON JR.
Title or Position: ASSISTANT SECRETARY OF ENROLLMENTS
Credential:
Phone: 425-358-9786