Provider Demographics
NPI:1558838029
Name:PW JADE LLC
Entity Type:Organization
Organization Name:PW JADE LLC
Other - Org Name:RIGHT AT HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:BROHMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-843-5192
Mailing Address - Street 1:1221 FARMERS LN STE A
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405-6712
Mailing Address - Country:US
Mailing Address - Phone:707-843-5192
Mailing Address - Fax:
Practice Address - Street 1:1221 FARMERS LN STE A
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405-6712
Practice Address - Country:US
Practice Address - Phone:707-843-5192
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-01
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care