# RAFAEL CONVALESCENT HOSPITAL

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1124178645
- **Authorized official:** MR. TIMOTHY EGAN (ADMINISTRATOR)
- **Authorized official phone:** (415) 479-3450

## Contact information

- **Practice address:** 234 N SAN PEDRO RD, SAN RAFAEL, CA 94903-2858
- **Practice address phone:** (415) 479-3450
- **Practice address fax:** (415) 472-3723
- **Mailing address:** 234 N SAN PEDRO RD, SAN RAFAEL, CA 94903-2858
- **Mailing address phone:** (415) 479-3450
- **Mailing address fax:** (415) 472-3723

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | — | — | Yes |

## Other

- **Enumeration date:** 01/10/2007
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | ZZR05310F4 | — | CA |