Healthcare Provider Details

I. General information

NPI: 1609877950
Provider Name (Legal Business Name): NAZARETH HOUSE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 NOVA ALBION WAY
SAN RAFAEL CA
94903-3539
US

IV. Provider business mailing address

245 NOVA ALBION WAY
SAN RAFAEL CA
94903-3539
US

V. Phone/Fax

Practice location:
  • Phone: 415-479-8282
  • Fax: 415-479-3878
Mailing address:
  • Phone: 415-479-8282
  • Fax: 415-479-3878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: SISTER ROSE HOYE
Title or Position: ADMINISTRATOR
Credential:
Phone: 415-479-8282