Organization
PETALUMA C.C. INC.
Active
Other names
PETALUMA CARE AND REHABILITATION
Organization subpart
No
Provider details
NPI number
Authorized official
MARC JOHNSON (CFO)
(949) 373-8373
Entity
Organization
Contact information
Practice address
1115 B ST, PETALUMA, CA 94952-4028
(707) 765-3030
Mailing address
1115 B ST, PETALUMA, CA 94952-4028
(707) 765-3030
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
010000056
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ZZR06072H
—
CA
Enumeration date
12/07/2005
Last updated
04/05/2024
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