Healthcare Provider Details

I. General information

NPI: 1811035710
Provider Name (Legal Business Name): SONOMA ACRES CONVALESCENT HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

765 DONALD ST
SONOMA CA
95476-4604
US

IV. Provider business mailing address

765 DONALD ST
SONOMA CA
95476-4604
US

V. Phone/Fax

Practice location:
  • Phone: 707-996-2161
  • Fax: 707-996-5874
Mailing address:
  • Phone: 707-996-2161
  • Fax: 707-996-5874

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number StateCA

VIII. Authorized Official

Name: CHONA BAUTISA
Title or Position: OFFICE MANAGER
Credential:
Phone: 909-373-3766