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NPI Code Detail

MEDICARE: NORTH BAY POST ACUTE, LLC

MEDICARE: NORTH BAY POST ACUTE, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1314000000XSkilled Nursing Facility

General Provider Information

NPI Number : 1104413517
Entity Type Code : Organization
Provider Name (Legal Business Name) : NORTH BAY POST ACUTE, LLC
Provider Business Mailing Address
First Line : 5404 WHITSETT AVE STE 182
Second Line :
City : VALLEY VILLAGE
State : CA
Zip : 91607-1615
Country : US
Telephone Number : 818-960-0295
Fax Number :
Provider Business Practice Location Address
First Line : 300 DOUGLAS ST
Second Line :
City : PETALUMA
State : CA
Zip : 94952-2503
Country : US
Telephone Number : 707-763-6887
Fax Number :
Authorized Official
Title or Position : MANAGER
Name : BRYAN TANNER
Credential :
Telephone Number : 707-763-6887
Provider Enumeration Date : 12/31/2020
Last Update Date : 03/02/2021

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