MEDICARE: SHERWOOD OAKS POST ACUTE CARE 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
1	314000000X	Skilled Nursing Facility

General Provider Information

NPI Number	:	1871269522
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHERWOOD OAKS POST ACUTE CARE LLC

Provider Business Mailing Address
First Line	:	130 DANA ST
Second Line	:
City	:	FORT BRAGG
State	:	CA
Zip	:	95437-4506
Country	:	US
Telephone Number	:	707-964-6333
Fax Number	:

Provider Business Practice Location Address
First Line	:	130 DANA ST
Second Line	:
City	:	FORT BRAGG
State	:	CA
Zip	:	95437-4506
Country	:	US
Telephone Number	:	707-964-6333
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	QING XIE
Credential	:
Telephone Number	:	510-962-8298

Provider Enumeration Date	:	08/20/2021
Last Update Date	:	02/17/2022

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