Healthcare Provider Details

I. General information

NPI: 1891739298
Provider Name (Legal Business Name): MILLS-PENINSULA HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 02/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 SO SAN MATEO DR
SAN MATEO CA
94401-3805
US

IV. Provider business mailing address

PO BOX 742738
LOS ANGELES CA
90074-2738
US

V. Phone/Fax

Practice location:
  • Phone: 650-696-5400
  • Fax: 696-652-3052
Mailing address:
  • Phone: 650-696-5400
  • Fax: 696-652-3052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number555482
License Number StateCA

VIII. Authorized Official

Name: MR. BRIAN TRENT HUNTER
Title or Position: VP SHARED SERVICES
Credential:
Phone: 916-297-8555