Provider Demographics
NPI:1194518209
Name:CORLINE HOLDINGS 2025 LLC
Entity type:Organization
Organization Name:CORLINE HOLDINGS 2025 LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:PERLA
Authorized Official - Middle Name:S
Authorized Official - Last Name:GUTIERREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-219-3441
Mailing Address - Street 1:91 GREGORY LN STE 17
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523-4927
Mailing Address - Country:US
Mailing Address - Phone:925-354-7761
Mailing Address - Fax:
Practice Address - Street 1:7025 CORLINE CT
Practice Address - Street 2:
Practice Address - City:SEBASTOPOL
Practice Address - State:CA
Practice Address - Zip Code:95472-4520
Practice Address - Country:US
Practice Address - Phone:650-219-3441
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-22
Last Update Date:2025-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility