Healthcare Provider Details

I. General information

NPI: 1437076411
Provider Name (Legal Business Name): J&J ASSISTED LIVING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1217 LANCE DR
SANTA ROSA CA
95401-4550
US

IV. Provider business mailing address

3615 CHANATE RD
SANTA ROSA CA
95404-1804
US

V. Phone/Fax

Practice location:
  • Phone: 707-548-8176
  • Fax: 707-575-1717
Mailing address:
  • Phone: 707-548-8176
  • Fax: 707-575-1717

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: JOSEPHINE CREDO ALCONES
Title or Position: MANAGER
Credential:
Phone: 707-548-8176