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Organization

PETALUMA SKILLED NURSING & WELLNESS CENTRE, LLC

Active
Other names
Country Villa Petaluma Healthcare Center
Organization subpart
No

Provider details

NPI number
Authorized official
MR. STEPHEN E. REISSMAN (CEO)
(310) 574-3733
Entity
Organization

Contact information

Practice address
523 HAYES LN, PETALUMA, CA 94952-4011
(707) 763-2457
(707) 765-2176
Mailing address
5120 W GOLDLEAF CIR, SUITE 400, LOS ANGELES, CA 90056-1292
(310) 574-3733
(310) 574-1322

Taxonomy

Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
LTC55703F
CA
Enumeration date
10/15/2007
Last updated
10/15/2007
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