Organization
ENSIGN SONOMA LLC
Active
Other names
Broadway Villa Post Acute
Organization subpart
No
Provider details
NPI number
Authorized official
SOON BURNAM (TREASURER)
(949) 540-1249
Entity
Organization
Contact information
Practice address
1250 BROADWAY, SONOMA, CA 95476-7500
(707) 938-8406
(707) 938-4400
Mailing address
1250 BROADWAY, SONOMA, CA 95476-7500
(707) 938-8406
(707) 938-4400
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
010000158
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ZZR05987K
—
CA
Enumeration date
08/02/2005
Last updated
02/17/2021
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