Healthcare Provider Details

I. General information

NPI: 1396205050
Provider Name (Legal Business Name): SONOMA SPECIALTY HOSPITAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2019
Last Update Date: 09/10/2020
Certification Date: 09/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 PETALUMA AVE
SEBASTOPOL CA
95472-4215
US

IV. Provider business mailing address

501 PETALUMA AVE
SEBASTOPOL CA
95472-4215
US

V. Phone/Fax

Practice location:
  • Phone: 707-823-8511
  • Fax:
Mailing address:
  • Phone: 707-823-8511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282E00000X
TaxonomyLong Term Care Hospital
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State

VIII. Authorized Official

Name: MRS. TAMMY JEAN THOMPSON
Title or Position: CFO VP FINANCE/OPERATIONS
Credential:
Phone: 209-248-7851