Provider Demographics
NPI:1124192364
Name:SLOW SCULPTURE
Entity Type:Organization
Organization Name:SLOW SCULPTURE
Other - Org Name:BADGER CREEK
Other - Org Type:Other Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:SARANE
Authorized Official - Middle Name:ALISON
Authorized Official - Last Name:BAKER-COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-537-7024
Mailing Address - Street 1:4520 BADGER RD
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95409-2631
Mailing Address - Country:US
Mailing Address - Phone:707-537-7024
Mailing Address - Fax:707-537-1753
Practice Address - Street 1:4520 BADGER RD
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95409-2631
Practice Address - Country:US
Practice Address - Phone:707-537-7024
Practice Address - Fax:707-537-1753
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility