Healthcare Provider Details

I. General information

NPI: 1649222506
Provider Name (Legal Business Name): ENSIGN PLEASANTON LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 02/17/2021
Certification Date: 02/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1349 S DORA ST
UKIAH CA
95482-6512
US

IV. Provider business mailing address

1349 S DORA ST
UKIAH CA
95482-6512
US

V. Phone/Fax

Practice location:
  • Phone: 707-462-8864
  • Fax: 707-462-0718
Mailing address:
  • Phone: 707-462-8864
  • Fax: 707-462-0718

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. SOON BURNAM
Title or Position: TREASURER
Credential:
Phone: 949-540-1249