OrganizationActive
Porcini LLC Wild Rose Living
NPI 1538048962 · Custodial Care Facility · Santa Rosa, CA
Provider details
- NPI number
- 1538048962
- Entity type
- Organization
- Primary specialty
- Custodial Care FacilityNursing & Custodial Care Facilities
- Authorized official
- Pamela Johnson, Managing Member/Administrator
Practice location
1172 Wild Rose Dr
Santa Rosa, CA 95401-5058
Phone: (707) 291-5756
Fax: (707) 838-0820
Mailing address
1172 Wild Rose Dr
Santa Rosa, CA 95401-5058
Registry dates
- Enumerated
- 2025-08-29
- Last updated
- 2025-11-20
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.