Provider Demographics
NPI:1770513004
Name:SEQUOIA LIVING INC.
Entity Type:Organization
Organization Name:SEQUOIA LIVING INC.
Other - Org Name:THE SEQUOIAS PORTOLA VALLEY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:MI NAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOYD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-202-7814
Mailing Address - Street 1:1525 POST ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94109-6567
Mailing Address - Country:US
Mailing Address - Phone:415-202-7800
Mailing Address - Fax:415-922-2338
Practice Address - Street 1:501 PORTOLA RD
Practice Address - Street 2:
Practice Address - City:PORTOLA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94028-7654
Practice Address - Country:US
Practice Address - Phone:650-851-1501
Practice Address - Fax:650-851-5007
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SEQUOIA LIVING INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-03
Last Update Date:2019-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA220000047314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
055466Medicare ID - Type Unspecified
CA055466Medicare Oscar/Certification