MEDICARE: SAN RAFAEL CARE CENTER, INC.

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
1	314000000X	Skilled Nursing Facility

General Provider Information

NPI Number	:	1639506371
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAN RAFAEL CARE CENTER, INC.

Provider Business Mailing Address
First Line	:	40 PROFESSIONAL CENTER PKWY
Second Line	:
City	:	SAN RAFAEL
State	:	CA
Zip	:	94903-2703
Country	:	US
Telephone Number	:	415-479-1230
Fax Number	:	415-492-0398

Provider Business Practice Location Address
First Line	:	40 PROFESSIONAL CENTER PKWY
Second Line	:
City	:	SAN RAFAEL
State	:	CA
Zip	:	94903-2703
Country	:	US
Telephone Number	:	415-479-1230
Fax Number	:	415-492-0398

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JAMES R PREIMESBERGER
Credential	:
Telephone Number	:	925-855-0881

Provider Enumeration Date	:	09/26/2013
Last Update Date	:	09/26/2013

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