Healthcare Provider Details

I. General information

NPI: 1821888231
Provider Name (Legal Business Name): MACAO HOLDINGS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2025
Last Update Date: 05/08/2025
Certification Date: 05/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 SONOMA AVE
SANTA ROSA CA
95404-4715
US

IV. Provider business mailing address

365 E CAMPBELL AVE
CAMPBELL CA
95008-2013
US

V. Phone/Fax

Practice location:
  • Phone: 707-544-7750
  • Fax:
Mailing address:
  • Phone:
  • 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: CHIEF ADMINISTRATIVE OFFICER
Credential:
Phone: 408-320-9897