Provider Demographics
NPI:1790770188
Name:SRM ALLIANCE HOSPITAL SERVICES
Entity Type:Organization
Organization Name:SRM ALLIANCE HOSPITAL SERVICES
Other - Org Name:HOSPICE OF PETALUMA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:C
Authorized Official - Last Name:RYDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-778-6242
Mailing Address - Street 1:416 PAYRAN ST
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94952-5907
Mailing Address - Country:US
Mailing Address - Phone:707-778-6242
Mailing Address - Fax:707-778-0144
Practice Address - Street 1:416 PAYRAN ST
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94952-5907
Practice Address - Country:US
Practice Address - Phone:707-778-6242
Practice Address - Fax:707-778-0144
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SANTA ROSA MEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-09-13
Last Update Date:2009-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA100000735315D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315D00000XNursing & Custodial Care FacilitiesHospice, Inpatient
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH01557GMedicaid
CAH01557GMedicaid