Healthcare Provider Details

I. General information

NPI: 1477077816
Provider Name (Legal Business Name): BRISTOL BAY HOLDINGS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2017
Last Update Date: 05/28/2023
Certification Date: 05/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

76 FENTON ST
LIVERMORE CA
94550-4144
US

IV. Provider business mailing address

76 FENTON ST
LIVERMORE CA
94550-4144
US

V. Phone/Fax

Practice location:
  • Phone: 925-443-1800
  • Fax:
Mailing address:
  • Phone: 925-443-1800
  • 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: TOBY TILFORD
Title or Position: CO-CEO
Credential:
Phone: 858-774-8342