Healthcare Provider Details

I. General information

NPI: 1306273636
Provider Name (Legal Business Name): MUIR WOOD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2013
Last Update Date: 09/25/2025
Certification Date: 09/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1733 SKILLMAN LN
PETALUMA CA
94952-1250
US

IV. Provider business mailing address

201 1ST ST STE 111
PETALUMA CA
94952-4291
US

V. Phone/Fax

Practice location:
  • Phone: 855-684-7966
  • Fax: 707-559-5401
Mailing address:
  • Phone: 855-684-7966
  • Fax: 707-781-4276

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number496803428
License Number StateCA

VIII. Authorized Official

Name: MR. BRYAN BOWEN
Title or Position: COO
Credential:
Phone: 415-497-7722