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Organization
1125 SIR FRANCIS DRAKE BOULEVARD OPERATING COMPANY, LLC
Active
Organization
1125 SIR FRANCIS DRAKE BOULEVARD OPERATING COMPANY, LLC
Active
Other names
Kentfield Rehabilitation & Specialty Hospital
Organization subpart
No
Provider details
NPI number
Authorized official
TAMMY JEAN THOMPSON (CFO/VP)
(209) 287-6308
Entity
Organization
Contact information
Practice address
1125 SIR FRANCIS DRAKE BLVD, KENTFIELD, CA 94904-1418
(415) 456-9680
(415) 485-3696
Mailing address
700 17TH ST STE 205, MODESTO, CA 95354-1249
(209) 287-6308
(209) 248-7825
Taxonomy
Speciality
Code
Description
License number
State
282E00000X
Long Term Care Hospital
Primary
110000358
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05-2043
FREMONT HEALTH
CA
05
—
HSC00554I
—
CA
05
—
HSP40554I
—
CA
05
—
ZZR005541
—
CA
Enumeration date
06/11/2006
Last updated
10/03/2023
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