Healthcare Provider Details

I. General information

NPI: 1083685606
Provider Name (Legal Business Name): HERMAN SANITARIUM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2006
Last Update Date: 03/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2295 PLUMMER AVE
SAN JOSE CA
95125-4767
US

IV. Provider business mailing address

2295 PLUMMER AVE
SAN JOSE CA
95125-4767
US

V. Phone/Fax

Practice location:
  • Phone: 408-269-0701
  • Fax: 408-269-2512
Mailing address:
  • Phone: 408-269-0701
  • Fax: 408-269-2512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number070000049
License Number StateCA

VIII. Authorized Official

Name: MANDY SAMATHA SOLLIS
Title or Position: OWNER
Credential:
Phone: 408-269-0701