Healthcare Provider Details

I. General information

NPI: 1104996933
Provider Name (Legal Business Name): KAISER FOUNDATION HOSPITALS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 04/22/2021
Certification Date: 04/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3550 ROUND BARN BLVD STE 112
SANTA ROSA CA
95403-1796
US

IV. Provider business mailing address

3550 ROUND BARN BLVD STE 112
SANTA ROSA CA
95403-1796
US

V. Phone/Fax

Practice location:
  • Phone: 707-566-5488
  • Fax:
Mailing address:
  • Phone: 707-566-5488
  • Fax: 707-566-5702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number010000259
License Number StateCA

VIII. Authorized Official

Name: JUDITH L COFFEY
Title or Position: SENIOR VICE PRESIDENT, AREA MANAGER
Credential:
Phone: 797-571-4222