Petaluma Icf Ddh INC
NPI #1265596373 in Sonoma, California
Provider Information
- NPI Number
- 1265596373
- Entity Type
- Organization
- Organization Name
- Petaluma Icf Ddh INC
- Primary Specialty
- Intermediate Care Facility, Intellectual Disabilities
- Enumeration Date
- Dec 21, 2006
- Last Updated
- Aug 22, 2020
Practice Location
- Address
- 805 PETALUMA AVE
- City
- Sonoma
- State
- California
- ZIP Code
- 95476
- Phone
- (707) 938-9195
Authorized Official
- Name
- MR. RICHARD ALBERT HIRE
- Title
- LICENSEE
- Phone
- (707) 894-3686
Specialties & Taxonomy Codes
| Specialty |
|---|
| Intermediate Care Facility, Intellectual Disabilities |
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