Provider Demographics
NPI:1770703886
Name:SRM ALLIANCE HOSPITAL SERVICES
Entity type:Organization
Organization Name:SRM ALLIANCE HOSPITAL SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHEL
Authorized Official - Middle Name:DANTE
Authorized Official - Last Name:RICCIONI
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:707-525-5320
Mailing Address - Street 1:1165 MONTGOMERY DR
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405-4801
Mailing Address - Country:US
Mailing Address - Phone:707-525-5300
Mailing Address - Fax:707-525-5392
Practice Address - Street 1:400 N MCDOWELL BLVD
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94954-2339
Practice Address - Country:US
Practice Address - Phone:707-778-2631
Practice Address - Fax:707-778-9117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA555447Medicare ID - Type Unspecified