Healthcare Provider Details

I. General information

NPI: 1306521554
Provider Name (Legal Business Name): MUIR WOOD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2023
Last Update Date: 09/25/2025
Certification Date: 09/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1830 BRADLEY ST
RIVERSIDE CA
92504-5435
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 310-903-1155
  • Fax: 707-559-5401
Mailing address:
  • Phone: 855-684-7966
  • Fax: 707-781-4276

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: HEATHER STRATFORD
Title or Position: VP OF PAYOR STRATEGY
Credential:
Phone: 831-566-5518