Provider Demographics
NPI:1861084857
Name:REDWOOD SANTA ROSA LLC
Entity type:Organization
Organization Name:REDWOOD SANTA ROSA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:BARBATO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-810-0145
Mailing Address - Street 1:6701 KOLL CENTER PKWY STE 250
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94566-8062
Mailing Address - Country:US
Mailing Address - Phone:415-810-0145
Mailing Address - Fax:
Practice Address - Street 1:1727 BURBANK AVE
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95407-7114
Practice Address - Country:US
Practice Address - Phone:707-843-2529
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REDWOOD SENIOR LIVING INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-02-10
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility