Healthcare Provider Details

I. General information

NPI: 1386880102
Provider Name (Legal Business Name): MILLS-PENINSULA HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2008
Last Update Date: 04/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

570 WILLOW RD
MENLO PARK CA
94025-2617
US

IV. Provider business mailing address

PO BOX 60000 FILE 74959
SAN FRANCISCO CA
94160-0001
US

V. Phone/Fax

Practice location:
  • Phone: 650-324-8500
  • Fax:
Mailing address:
  • Phone: 650-652-3803
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number220000276
License Number StateCA

VIII. Authorized Official

Name: JOHN GATES
Title or Position: CFO SHBA
Credential:
Phone: 510-450-7357