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General NPI Number Information
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NPI Number | 1396295531
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Entity Type | Organization
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Legal Business Name | PINE FLAT RANCH, INC.
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Dates
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Enumeration Date | 10/12/2016
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Last Update Date | 10/12/2016
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Provider Practice Location Address
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Address Line | 170 FARMERS LN STE 11
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City | SANTA ROSA
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State | CA
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Zip | 95405-4750
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Country | US
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Telephone | 707-843-3851
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Fax | 707-595-3227
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Provider Business Mailing Address
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Address Line | 170 FARMERS LN STE 11
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City | SANTA ROSA
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State | CA
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Zip | 95405-4750
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Country | US
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Telephone | 707-843-3851
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Fax | 707-595-3227
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Authorized Official
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Title or Position | OWNER-PRESIDENT
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Name | MR. PETER JOHN HOLEWINSKI
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Credential |
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Telephone | 707-843-3851
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | HCO494700016
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License Number State | CA
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