Healthcare Provider Details

I. General information

NPI: 1881372019
Provider Name (Legal Business Name): FIJI HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2023
Last Update Date: 07/07/2023
Certification Date: 06/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

755 BAYWOOD DR STE 200
PETALUMA CA
94954-5508
US

IV. Provider business mailing address

755 BAYWOOD DR STE 200
PETALUMA CA
94954-5508
US

V. Phone/Fax

Practice location:
  • Phone: 707-774-3634
  • Fax:
Mailing address:
  • Phone: 707-774-3634
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: ANNE MARIE HURSTEL
Title or Position: DIRECTOR ASSISTANT ADMIN
Credential: LVN
Phone: 707-205-7802