MEDICARE: ENSIGN SONOMA 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	010000158	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1871594614
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ENSIGN SONOMA LLC

Provider Business Mailing Address
First Line	:	1250 BROADWAY
Second Line	:
City	:	SONOMA
State	:	CA
Zip	:	95476-7500
Country	:	US
Telephone Number	:	707-938-8406
Fax Number	:	707-938-4400

Provider Business Practice Location Address
First Line	:	1250 BROADWAY
Second Line	:
City	:	SONOMA
State	:	CA
Zip	:	95476-7500
Country	:	US
Telephone Number	:	707-938-8406
Fax Number	:	707-938-4400

Authorized Official
Title or Position	:	TREASURER
Name	:	SOON BURNAM
Credential	:
Telephone Number	:	949-540-1249

Provider Enumeration Date	:	08/02/2005
Last Update Date	:	02/17/2021

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Directions to “ENSIGN SONOMA LLC ” Practice Location

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