Healthcare Provider Details

I. General information

NPI: 1639506371
Provider Name (Legal Business Name): SAN RAFAEL CARE CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2013
Last Update Date: 09/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 PROFESSIONAL CENTER PKWY
SAN RAFAEL CA
94903-2703
US

IV. Provider business mailing address

40 PROFESSIONAL CENTER PKWY
SAN RAFAEL CA
94903-2703
US

V. Phone/Fax

Practice location:
  • Phone: 415-479-1230
  • Fax: 415-492-0398
Mailing address:
  • Phone: 415-479-1230
  • Fax: 415-492-0398

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JAMES R PREIMESBERGER
Title or Position: PRESIDENT
Credential:
Phone: 925-855-0881