Healthcare Provider Details

I. General information

NPI: 1619832193
Provider Name (Legal Business Name): FERNWOOD CARE FACILITY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 FERNWOOD CT
SANTA ROSA CA
95401-6070
US

IV. Provider business mailing address

116 FERNWOOD CT
SANTA ROSA CA
95401-6070
US

V. Phone/Fax

Practice location:
  • Phone: 707-321-3711
  • Fax:
Mailing address:
  • Phone: 707-321-3711
  • Fax:

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: ANTONIO GONZALES CRUZ
Title or Position: LICENSEE
Credential:
Phone: 707-321-3711