Healthcare Provider Details

I. General information

NPI: 1255622817
Provider Name (Legal Business Name): WINDSOR CARE CENTER OF PETALUMA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2011
Last Update Date: 04/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

523 HAYES LN
PETALUMA CA
94952-4011
US

IV. Provider business mailing address

9200 W SUNSET BLVD SUITE 700
WEST HOLLYWOOD CA
90069-3502
US

V. Phone/Fax

Practice location:
  • Phone: 707-763-2457
  • Fax: 707-347-4705
Mailing address:
  • Phone: 310-385-1090
  • Fax: 310-595-3752

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number010000010
License Number StateCA

VIII. Authorized Official

Name: MR. ASH CHAWLA
Title or Position: VICE PRESIDENT OF FINANCE
Credential:
Phone: 310-385-1078