# MILLS-PENINSULA HEALTH SERVICES

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Mills Peninsula Extended Care
- **Organization subpart:** No

## Provider details

- **NPI number:** 1891739298
- **Authorized official:** MR. BRIAN TRENT HUNTER (VP SHARED SERVICES)
- **Authorized official phone:** (916) 297-8555

## Contact information

- **Practice address:** 101 SO SAN MATEO DR, SAN MATEO, CA 94401-3805
- **Practice address phone:** (650) 696-5400
- **Practice address fax:** (696) 652-3052
- **Mailing address:** PO BOX 742738, LOS ANGELES, CA 90074-2738
- **Mailing address phone:** (650) 696-5400
- **Mailing address fax:** (696) 652-3052

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 555482 | CA | Yes |

## Other

- **Enumeration date:** 06/15/2006
- **Last updated:** 02/27/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | LTC55482F | — | CA |