=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568375723
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PLACE LIKE HOME III, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/28/2026
-----------------------------------------------------
Last Update Date | 09/28/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9020 SONOMA HWY
-----------------------------------------------------
City | KENWOOD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95452-9028
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 707-582-9003
-----------------------------------------------------
Fax | 707-867-1773
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9020 SONOMA HWY
-----------------------------------------------------
City | KENWOOD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95452-9028
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 707-582-9003
-----------------------------------------------------
Fax | 707-867-1773
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | BANA SOLOMON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 707-800-2522
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NULL
-----------------------------------------------------