Healthcare Provider Details

I. General information

NPI: 1568459147
Provider Name (Legal Business Name): SEBASTOPOL CONVALESCENT HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2005
Last Update Date: 06/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

477 PETALUMA AVE
SEBASTOPOL CA
95472-4206
US

IV. Provider business mailing address

477 PETALUMA AVE
SEBASTOPOL CA
95472-4206
US

V. Phone/Fax

Practice location:
  • Phone: 707-823-7855
  • Fax: 707-823-8047
Mailing address:
  • Phone: 707-823-7855
  • Fax: 707-823-8047

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: MR. KENNETH CHAMBERS
Title or Position: OFFICE MANAGER
Credential:
Phone: 707-823-7855