# ENSIGN SONOMA LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Broadway Villa Post Acute
- **Organization subpart:** No

## Provider details

- **NPI number:** 1871594614
- **Authorized official:** SOON BURNAM (TREASURER)
- **Authorized official phone:** (949) 540-1249

## Contact information

- **Practice address:** 1250 BROADWAY, SONOMA, CA 95476-7500
- **Practice address phone:** (707) 938-8406
- **Practice address fax:** (707) 938-4400
- **Mailing address:** 1250 BROADWAY, SONOMA, CA 95476-7500
- **Mailing address phone:** (707) 938-8406
- **Mailing address fax:** (707) 938-4400

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 010000158 | CA | Yes |

## Other

- **Enumeration date:** 08/02/2005
- **Last updated:** 02/17/2021

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | ZZR05987K | — | CA |