Healthcare Provider Details

I. General information

NPI: 1790770188
Provider Name (Legal Business Name): SRM ALLIANCE HOSPITAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2005
Last Update Date: 11/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

416 PAYRAN ST
PETALUMA CA
94952-5907
US

IV. Provider business mailing address

416 PAYRAN ST
PETALUMA CA
94952-5907
US

V. Phone/Fax

Practice location:
  • Phone: 707-778-6242
  • Fax: 707-778-0144
Mailing address:
  • Phone: 707-778-6242
  • Fax: 707-778-0144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code315D00000X
TaxonomyInpatient Hospice
License Number100000735
License Number StateCA

VIII. Authorized Official

Name: JUDITH C RYDER
Title or Position: DIRECTOR
Credential:
Phone: 707-778-6242