Healthcare Provider Details

I. General information

NPI: 1194518209
Provider Name (Legal Business Name): CORLINE HOLDINGS 2025 LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2025
Last Update Date: 05/22/2025
Certification Date: 05/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7025 CORLINE CT
SEBASTOPOL CA
95472-4520
US

IV. Provider business mailing address

91 GREGORY LN STE 17
PLEASANT HILL CA
94523-4927
US

V. Phone/Fax

Practice location:
  • Phone: 650-219-3441
  • Fax:
Mailing address:
  • Phone: 925-354-7761
  • 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: MS. PERLA S GUTIERREZ
Title or Position: CFO
Credential:
Phone: 650-219-3441