Provider Demographics
NPI:1609907815
Name:STEVEN P LENSCHMIDT, LLC
Entity type:Organization
Organization Name:STEVEN P LENSCHMIDT, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:P
Authorized Official - Last Name:LENSCHMIDT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-823-7855
Mailing Address - Street 1:477 PETALUMA AVE
Mailing Address - Street 2:
Mailing Address - City:SEBASTOPOL
Mailing Address - State:CA
Mailing Address - Zip Code:95472-4206
Mailing Address - Country:US
Mailing Address - Phone:707-823-7855
Mailing Address - Fax:707-823-8047
Practice Address - Street 1:477 PETALUMA AVE
Practice Address - Street 2:
Practice Address - City:SEBASTOPOL
Practice Address - State:CA
Practice Address - Zip Code:95472-4206
Practice Address - Country:US
Practice Address - Phone:707-823-7855
Practice Address - Fax:707-823-8047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
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
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZR05520JMedicaid
055520Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER