# PETALUMA C.C. INC.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** PETALUMA CARE AND REHABILITATION
- **Organization subpart:** No

## Provider details

- **NPI number:** 1659356160
- **Authorized official:** MARC JOHNSON (CFO)
- **Authorized official phone:** (949) 373-8373

## Contact information

- **Practice address:** 1115 B ST, PETALUMA, CA 94952-4028
- **Practice address phone:** (707) 765-3030
- **Mailing address:** 1115 B ST, PETALUMA, CA 94952-4028
- **Mailing address phone:** (707) 765-3030

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 010000056 | CA | Yes |

## Other

- **Enumeration date:** 12/07/2005
- **Last updated:** 04/05/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | ZZR06072H | — | CA |