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General NPI Number Information
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NPI Number | 1255622817
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Entity Type | Organization
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Legal Business Name | WINDSOR CARE CENTER OF PETALUMA LLC
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Dates
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Enumeration Date | 04/29/2011
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Last Update Date | 04/29/2011
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Provider Practice Location Address
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Address Line | 523 HAYES LN
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City | PETALUMA
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State | CA
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Zip | 94952-4011
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Country | US
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Telephone | 707-763-2457
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Fax | 707-347-4705
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Provider Business Mailing Address
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Address Line | 9200 W SUNSET BLVD SUITE 700
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City | WEST HOLLYWOOD
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State | CA
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Zip | 90069-3502
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Country | US
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Telephone | 310-385-1090
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Fax | 310-595-3752
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Authorized Official
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Title or Position | VICE PRESIDENT OF FINANCE
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Name | MR. ASH CHAWLA
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Credential |
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Telephone | 310-385-1078
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 010000010
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License Number State | CA
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