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General NPI Number Information
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NPI Number | 1477077816
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Entity Type | Organization
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Legal Business Name | BRISTOL BAY HOLDINGS LLC
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Dates
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Enumeration Date | 07/27/2017
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Last Update Date | 05/28/2023
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Provider Practice Location Address
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Address Line | 76 FENTON ST
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City | LIVERMORE
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State | CA
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Zip | 94550-4144
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Country | US
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Telephone | 925-443-1800
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Fax |
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Provider Business Mailing Address
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Address Line | 76 FENTON ST
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City | LIVERMORE
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State | CA
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Zip | 94550-4144
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Country | US
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Telephone | 925-443-1800
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Fax |
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Authorized Official
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Title or Position | CO-CEO
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Name | TOBY TILFORD
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Credential |
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Telephone | 858-774-8342
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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 |
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License Number State |
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