Healthcare Provider Details

I. General information

NPI: 1962536912
Provider Name (Legal Business Name): SRM ALLIANCE HOSPITAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 N MCDOWELL BLVD
PETALUMA CA
94954-2339
US

IV. Provider business mailing address

400 N MCDOWELL BLVD
PETALUMA CA
94954-2339
US

V. Phone/Fax

Practice location:
  • Phone: 707-778-2631
  • Fax: 707-778-9117
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. MICHEL RICCIONI
Title or Position: CFO
Credential:
Phone: 707-525-5320