Organization
PORCINI LLC WILD ROSE LIVING
Active
Other names
Wild Rose Living
Organization subpart
No
Provider details
NPI number
Authorized official
PAMELA JOHNSON (MANAGING MEMBER/ADMINISTRATOR)
(707) 291-5756
Entity
Organization
Contact information
Practice address
1172 WILD ROSE DR, SANTA ROSA, CA 95401-5058
(707) 291-5756
(707) 838-0820
Mailing address
1172 WILD ROSE DR, SANTA ROSA, CA 95401-5058
(707) 291-5756
(707) 838-0820
Taxonomy
Speciality
Code
Description
License number
State
311Z00000X
Custodial Care Facility
Primary
—
—
Other
Enumeration date
08/29/2025
Last updated
11/20/2025
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