Healthcare Provider Details

I. General information

NPI: 1740698919
Provider Name (Legal Business Name): PETALUMA HEALTHCARE & WELLNESS CENTRE, LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2014
Last Update Date: 07/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

523 HAYES LN
PETALUMA CA
94952-4011
US

IV. Provider business mailing address

5900 WILSHIRE BLVD SUITE 1600
LOS ANGELES CA
90036-5013
US

V. Phone/Fax

Practice location:
  • Phone: 707-763-2457
  • Fax: 707-763-4860
Mailing address:
  • Phone: 323-330-6500
  • Fax: 866-603-3566

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: MR. SHLOMO RECHNITZ
Title or Position: MANAGING MEMBER
Credential:
Phone: 323-634-1940