Provider Demographics
NPI:1811035710
Name:SONOMA ACRES CONVALESCENT HOSPITAL
Entity Type:Organization
Organization Name:SONOMA ACRES CONVALESCENT HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHONA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAUTISA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-373-3766
Mailing Address - Street 1:765 DONALD ST
Mailing Address - Street 2:
Mailing Address - City:SONOMA
Mailing Address - State:CA
Mailing Address - Zip Code:95476-4604
Mailing Address - Country:US
Mailing Address - Phone:707-996-2161
Mailing Address - Fax:707-996-5874
Practice Address - Street 1:765 DONALD ST
Practice Address - Street 2:
Practice Address - City:SONOMA
Practice Address - State:CA
Practice Address - Zip Code:95476-4604
Practice Address - Country:US
Practice Address - Phone:707-996-2161
Practice Address - Fax:707-996-5874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
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