Organization
EVERGREEN AT PETALUMA, L.L.C.
Active
Parent organization
EMPRES CALIFORNIA HEALTHCARE, L.L.C.
Other names
EmpRes Post Acute Rehabilitation
Organization subpart
Yes
Provider details
NPI number
Legal business name
EMPRES CALIFORNIA HEALTHCARE, L.L.C.
Authorized official
BRENT WEIL (CEO AND MANAGER)
(360) 892-6628
Entity
Organization
Contact information
Practice address
300 DOUGLAS ST, PETALUMA, CA 94952-2503
(707) 763-6887
(707) 763-0314
Mailing address
4601 NE 77TH AVE, SUITE 300, VANCOUVER, WA 98662-6729
(360) 892-6628
(360) 882-5793
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
010000018
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ZZRO6120J
—
CA
Enumeration date
05/04/2006
Last updated
01/30/2017
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