Healthcare Provider Details

I. General information

NPI: 1558883645
Provider Name (Legal Business Name): SANTA ROSA POSTACUTE CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2017
Last Update Date: 11/19/2024
Certification Date: 11/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

446 ARROWOOD DR
SANTA ROSA CA
95407-7503
US

IV. Provider business mailing address

721 N EUCLID ST STE 200
ANAHEIM CA
92801-4116
US

V. Phone/Fax

Practice location:
  • Phone: 707-528-2100
  • Fax: 562-457-5584
Mailing address:
  • Phone: 424-349-7108
  • Fax: 562-457-5584

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: MANEESH A. BANSAL
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 424-349-7108