Healthcare Provider Details

I. General information

NPI: 1730011602
Provider Name (Legal Business Name): WINDANSEA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4518 54TH ST
SAN DIEGO CA
92115-3527
US

IV. Provider business mailing address

599 MENLO DR STE 200
ROCKLIN CA
95765-3725
US

V. Phone/Fax

Practice location:
  • Phone: 619-287-2920
  • Fax:
Mailing address:
  • Phone: 916-299-7030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: RYAN WILLIAMS
Title or Position: MANAGING MEMBER
Credential:
Phone: 916-945-1248