Provider Demographics
NPI:1235823550
Name:PITAYA HEALTHCARE LLC
Entity Type:Organization
Organization Name:PITAYA HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:NICCOLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-449-8000
Mailing Address - Street 1:101 S ORCHARD AVE
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95688-3635
Mailing Address - Country:US
Mailing Address - Phone:707-448-6458
Mailing Address - Fax:
Practice Address - Street 1:101 S ORCHARD AVE
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95688-3635
Practice Address - Country:US
Practice Address - Phone:707-448-6458
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-08
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility