Healthcare Provider Details

I. General information

NPI: 1568375723
Provider Name (Legal Business Name): PLACE LIKE HOME III, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9020 SONOMA HWY
KENWOOD CA
95452-9028
US

IV. Provider business mailing address

9020 SONOMA HWY
KENWOOD CA
95452-9028
US

V. Phone/Fax

Practice location:
  • Phone: 707-582-9003
  • Fax: 707-867-1773
Mailing address:
  • Phone: 707-582-9003
  • Fax: 707-867-1773

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: BANA SOLOMON
Title or Position: OWNER
Credential:
Phone: 707-800-2522