Healthcare Provider Details

I. General information

NPI: 1760496566
Provider Name (Legal Business Name): NADHAN INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 01/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 SONOMA AVE
SANTA ROSA CA
95404-4715
US

IV. Provider business mailing address

850 SONOMA AVE
SANTA ROSA CA
95404-4715
US

V. Phone/Fax

Practice location:
  • Phone: 707-544-7750
  • Fax: 707-578-2140
Mailing address:
  • Phone: 707-544-7750
  • Fax: 707-578-2140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number47038260
License Number StateCA

VIII. Authorized Official

Name: PREMA THEKKEK
Title or Position: VICE PRESIDENT
Credential:
Phone: 707-544-7750