Provider Demographics
NPI:1386632438
Name:MILLBRAE SERRA SANITARIUM INC.
Entity Type:Organization
Organization Name:MILLBRAE SERRA SANITARIUM INC.
Other - Org Name:MILLBRAE SERRA CONVALESCENT HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VINCE
Authorized Official - Middle Name:
Authorized Official - Last Name:MUZZI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-697-7000
Mailing Address - Street 1:150 SERRA AVE
Mailing Address - Street 2:
Mailing Address - City:MILLBRAE
Mailing Address - State:CA
Mailing Address - Zip Code:94030-2629
Mailing Address - Country:US
Mailing Address - Phone:650-697-7000
Mailing Address - Fax:
Practice Address - Street 1:150 SERRA AVE
Practice Address - Street 2:
Practice Address - City:MILLBRAE
Practice Address - State:CA
Practice Address - Zip Code:94030-2629
Practice Address - Country:US
Practice Address - Phone:650-697-7000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZR18147FMedicaid
CA555602Medicare ID - Type Unspecified