Provider Demographics
NPI:1952547788
Name:MILLS-PENINSULA HEALTH SERVICES
Entity Type:Organization
Organization Name:MILLS-PENINSULA HEALTH SERVICES
Other - Org Name:MILLS-PENINSULA SENIOR FOCUS CENTER ADULT DAY HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:MERWIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-696-5270
Mailing Address - Street 1:PO BOX 60000
Mailing Address - Street 2:FILE 73688
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94160-0001
Mailing Address - Country:US
Mailing Address - Phone:650-652-3803
Mailing Address - Fax:
Practice Address - Street 1:1720 EL CAMINO REAL
Practice Address - Street 2:SUITE 10
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-3225
Practice Address - Country:US
Practice Address - Phone:650-696-3660
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MILLS-PENINSULA HEALTH SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-12-29
Last Update Date:2008-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA070000551261QR0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAADU70045FMedicaid