Healthcare Provider Details

I. General information

NPI: 1003643735
Provider Name (Legal Business Name): IMOLA HOLDINGS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2024
Last Update Date: 06/06/2025
Certification Date: 06/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 N WINCHESTER BLVD
SANTA CLARA CA
95050-6325
US

IV. Provider business mailing address

365 E CAMPBELL AVE
CAMPBELL CA
95008-2013
US

V. Phone/Fax

Practice location:
  • Phone: 408-248-3736
  • Fax:
Mailing address:
  • Phone: 408-320-9897
  • Fax:

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: ROBERT BRANDI
Title or Position: CFO
Credential:
Phone: 408-320-9897