Healthcare Provider Details

I. General information

NPI: 1457285512
Provider Name (Legal Business Name): MUIR WOOD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16930 WASHINGTON ST
RIVERSIDE CA
92504-6149
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 415-497-7722
  • Fax: 707-781-4287
Mailing address:
  • Phone: 415-497-7722
  • Fax: 707-781-4287

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

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