Basic Information
| Provider Information | |||||||||
| NPI: | 1922462431 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SUTTER BAY HOSPITALS | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | MILLS-PENINSULA SENIOR FOCUS CENTER ADULT DAY HEALTH | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2000 POWELL ST | ||||||||
| Address2: | 10TH FLOOR | ||||||||
| City: | EMERYVILLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 946081804 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5104507347 | ||||||||
| FaxNumber: | 5104507309 | ||||||||
| Practice Location | |||||||||
| Address1: | 1720 EL CAMINO REAL | ||||||||
| Address2: | SUITE 10 | ||||||||
| City: | BURLINGAME | ||||||||
| State: | CA | ||||||||
| PostalCode: | 940103224 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6506963660 | ||||||||
| FaxNumber: | 6506963633 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/11/2016 | ||||||||
| LastUpdateDate: | 01/20/2022 | ||||||||
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| AuthorizedOfficialLastName: | GATES | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 5104507357 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 01/20/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 311ZA0620X | Y | Nursing & Custodial Care Facilities | Custodial Care Facility | Adult Care Home |
No ID Information.