Healthcare Provider Details

I. General information

NPI: 1376515817
Provider Name (Legal Business Name): FMSC SAN RAFAEL OPERATING COMPANY LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2006
Last Update Date: 06/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 PROFESSIONAL CENTER PKWY
SAN RAFAEL CA
94903-2702
US

IV. Provider business mailing address

45 PROFESSIONAL CENTER PKWY
SAN RAFAEL CA
94903-2702
US

V. Phone/Fax

Practice location:
  • Phone: 415-479-3610
  • Fax:
Mailing address:
  • Phone: 415-479-3610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number314000000
License Number StateCA

VIII. Authorized Official

Name: MRS. ANDREA SAAVEDRA
Title or Position: REGIONAL FINANCIAL ANALYST
Credential:
Phone: 707-208-1940