Provider Demographics
NPI:1386009108
Name:1125 SIR FRANCIS DRAKE BOULEVARD OPERATING COMPANY, LLC
Entity Type:Organization
Organization Name:1125 SIR FRANCIS DRAKE BOULEVARD OPERATING COMPANY, LLC
Other - Org Name:KENTFIELD HOSPITAL SAN FRANCISCO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO/VP
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-287-6308
Mailing Address - Street 1:700 17TH ST STE 205
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95354-1249
Mailing Address - Country:US
Mailing Address - Phone:209-287-6308
Mailing Address - Fax:209-248-7825
Practice Address - Street 1:450 STANYAN ST
Practice Address - Street 2:6TH FLOOR
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94117-1019
Practice Address - Country:US
Practice Address - Phone:415-456-9680
Practice Address - Fax:415-688-3202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-21
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA282E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282E00000XHospitalsLong Term Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA052043Medicare Oscar/Certification