Provider Demographics
NPI:1003643735
Name:IMOLA HOLDINGS LLC
Entity type:Organization
Organization Name:IMOLA HOLDINGS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:BRANDI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-320-9897
Mailing Address - Street 1:365 E CAMPBELL AVE
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95008-2013
Mailing Address - Country:US
Mailing Address - Phone:408-320-9897
Mailing Address - Fax:
Practice Address - Street 1:410 N WINCHESTER BLVD
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95050-6325
Practice Address - Country:US
Practice Address - Phone:408-248-3736
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-17
Last Update Date:2025-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility